Has anyone left the NHS to set up private practice?

[Buccabucca]

Hi, I currently work as a clinical psychologist in the NHS but I'm growing increasingly frustrated and tired of the endless government targets, management crap, bureaucracy and lack of resources. I am now seriously thinking of leaving and setting up my own private practice.

Does anyone have any experiences they could share with me of setting up a private therapy practice? Many thanks :)

[SuzanneUK]

Private therapy practices come in a wide variety of shapes, sizes, styles and levels of professional competence.

If you offer relief from stress, can the client expect years of psychotherapy or just a quick hand-job?

It might seem like a jokey question but it's perfectly reasonable one, based upon the proliferation of therapists offering all kinds of often-ill-defined services.

With the NHS, a client can confidently expect a decent level of service. Whether or not he gets it is a different matter of course but, in the private sector, he can end up being treated by all manner of incompetent idiots with all manner of meaningless letters after their names.

And most people know that's the situation.

That's just one of the problems you're up against.

[Buccabucca]

Yes I imagine there are all sorts of charlatans out there. At least I have a degree plus a doctorate in clinical psychology plus 13 years clinical experience working in the nhs. I guess I'd need to really ensure this stands out in my advertising!

[Buccabucca]

Any other problems you've encountered Suzanneuk?

[KatoPotato]

I work in marketing for a private acute mental health provider. I do many events educating Consultants about starting in private practice, I could send you a pdf of our guide if that helps?

In my experience it helps to have a need for money, private school etc!

[googlenut]

What about specialising in something eg CBT.

[AlicanteLullaby]

Hi. A little different, but I left the local authority to set up in practice as a private educational psychologist a couple of years ago. I am so glad that I did. It's daunting at first but the best professional decision I have every made.

Here are some ideas:

The BPS does a training workshop for practitioners thinking about setting up in private practice, which may be worth attending.

There is the BPS Independent Practitioners forum (email Carl Boucher to join) and the newly established IP SIG within the BPS. It is also worth making links with other psychologists you know who work independently. I have found that most are happy to share ideas and information. I also have a number of friends and ex-colleagues who I use for cross-referrals

I eased myself into private work by working as an associate for 2 more established private practices, which gave me the confidence that I was 'doing it right', a good level of supervision and an idea of the sorts of issues that need thinking about. It also gave me an idea of how I wanted my practice to 'feel' to clients, where I wanted to focus my practice and how to do things differently (where appropriate) to more established practices. Alongside that I gradually established my own client base and now work mostly for my own practice. I guess that you can also look at private healthcare providers to give you a steady income stream, although it can be a bit of a headache, as I understand!

You will need a good supervisor. One of the nicest things about working privately is that I get to choose a supervisor who is compatible with my ways of working. I also like being able to choose my CPD and am using some of the time I have freed up from the (relatively) better income to begin my training in Systemic Psychotherapy. The BPS has a list of approved supervisors.

It also really helps to know someone who runs their own business (any sort of business) who can explain the ins and outs of tax returns etc. It's quite simple, but daunting at first. I use a small business accountant, who saves me more money than I spend on him!

Best of luck, I hope that helps a bit. :)

[Buccabucca]

Thanks so much for all the helpful responses! Katopotato, that PDF would be fantastic thanks.

Alicante, you sound like you're doing really well! I saw the BPS do workshops but they are in London which is too far for me to travel. Plus i let my BPS membership lapse so I would probably need to rejoin? I've bought a book on setting up private practice so hopefully that will help. My plan is to try to do one morning / one day at first alongside my 3 days in NHS. Then if it seems a goer, eventually drop the NHS. I shudder at the thought of having to work in NHS for another 30 odd years!

Do you pay for supervision? Or can you do peer supervision? How do you get referrals?

Re tax returns etc, my DH is an accountant so that's sorted!

[AlicanteLullaby]

If your husband is an accountant that is a huge advantage! The idea of being self employed, filing tax returns etc. put me off private work for years. Now I am up and running , it's the least of my worries!
I would really recommend joining the BPS. It's a good way to keep up with developments outside the structure of a large organisation and a good way of accessing support.
My referrals come from independent schools I have developed relationships with, some state schools who choose to buy in my services on top of their local authority service and from my website. Working part time in the NHS and building up slowly is an excellent way to get started. There is an organisation for child psychologists in private practice, with a searchable directory, so referrals also come from there. At the moment my problem is capacity. I am turning down more work than I am accepting! I don't do tribunal work, or expert witness work.
One thing that is worth thinking of is how to create a business model that works for you, in terms of the work you take on. For example I prefer to take on complex, one-off pieces of assessment than lots of ongoing therapeutic work. If working with schools, I offer a day rate which can be divided into two assessments , or a couple of home visits or some supervision for staff. I also do some pro bono work and will be doing some CAMHS work for free to get some more family therapy experience.
I pay for supervision. My supervisor is a systemic therapist and ed psych and charges me her client rate for an hours supervision each month. I also access formal and informal supervision with peers and still take one a few associate cases for a practice as the manager takes time to read and comment on my reports, which is good for my CPD.

[Buccabucca]

Thanks alicante, that's lots more helpful info. You sound busy! Do you know any clinical psychologists who are private?

Did you gradually leave LA? Or did you just up and leave? What makes you think it's the best decision you've made?

[AlicanteLullaby]

I know a couple of clin psychs who work privately. One who works with two other women she trained with as part of a small consortium and another who works in a private practice with children and families. They get a lot of referrals from GPs as well as private consultants.

I left the local authority while on maternity leave so was able to start on a day a fortnight and went up to 3 days per week by the end of the year. I would say that I actually work harder now, although much more flexibly. I often finish work at 3 and then pick up again in the evening. I enjoy having that flexibility and being able to choose my work schedule, I enjoy being unconstrained by working within the boundaries of a large organisation and by the whims of my boss. I now quite enjoy the business development side of things and am looking forward to growing the practice when the time is right. I love being able to decide my CPD schedule. In my last job I was 'mummy tracked' as soon as I had children- such as having my specialism taken away and being given less responsibility following maternity leave. That really knocked my confidence so working indecently has really helped to restore that and is something g I feel proud of ( and a bit smug about when I last saw my ex-boss ;) . At first I found the extent to which it can eat into your private time very draining- completing reports at weekends, parents calling in the evening. It is important to build systems into deal with that, which I didn't when I first started. It is also important to know your weaknesses and build in processes for managing those. Mine is making minor typos in reports- I now pay a proofreader which has massively reduced my level of stress!

[AlicanteLullaby]

Working indecently!? independently of course- still coming to terms with the iPad auto correct!

[Buccabucca]

Thanks for the info alicante, lots to think about! I phoned a local GP surgery today to ask the practice manager about private referrals and he didn't know anything and advised me to speak to the gp's. I've found a few therapy rooms nearby at £5/£6 an hour which seems reasonable.

Do you see clients far from your home? There are clinic rooms in the town I live but they are literally just up the road so I'd be concerned about boundaries etc. I would also put strict boundaries on clients calling me out with sessions.

[AlicanteLullaby]

Hi. Most of the work I do is school based. I sometimes work in schools in a town about four miles from home, but only go into the town for work as we live close to a nicer city for shopping etc and my clients don't tend to leave town too often! I work in private schools all over but have had issues with realising that families I work with are friends of friends etc, I suppose that could easily happen in a public sector job too though. If someone in my village refers to me, I do tend to pass the referral on. I have just started using a consulting room in our village, but that tends to be when a family wants to see me but I can't make it out to them. I may start doing more clinic based work but I am mindful of the boundary issue. Lots of talk about that sort of thing on the indecent practitioner forums and the BPS has some useful guidelines. In terms of contact out of sessions you do have to be clear about boundaries and make sure that clients know where to go if a crisis happens. Again, there is guidance around this.
Good luck!

[Buccabucca]

Lol iPad typo again- indecent practitioners lol!

Thanks again for all your advice, you've been very very helpful :)