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Go big or start small?

Two GPs who run successful private services alongside their NHS work describe their very different approaches to starting up.

“Don’t get too big too soon”

Dr David Edwards is a GP in Chipping Norton, Oxfordshire and runs an erectile dysfunction service from his surgery.

I was working full time in NHS general practice but – for several reasons- I decided to reduce my days to two. One reason was that I had started a postgraduate degree in medical anthropology.

But I had also developed an increasing interest in men’s health and sexual dysfunction and had become frustrated that there was only a limited amount I could offer these men. It’s not just that the ability to have an erect penis is vital to a man- but that erectile dysfunction also means there are other pathologies involved as well.


41268862I then spent about 10 years trying to get funding for a NHS sexual dysfunction clinic from the PCT but kept getting the same impression- that the trust managers thought sex was a dirty word.

Then Pfizer approached me – after hearing the difficulties I was having – and with their help I set up the service. But I realised early on that I didn’t want one company to be the only sponsor and involved more.

So now in the service each man is seen via three basic funding mechanisms:

• On the NHS- dependant on fluctuating support

• Part- pharma sponsored

• Privately

But the accounts for all three have to be kept totally separate.

Running this sort of service from the practice has obvious advantages – in terms of the cost of surgery space and sharing backroom functions. But you have to keep your partners happy and key to this is keeping everything squeaky clean financially. If I had to give one piece of advice to anyone starting this sort of service it would be: you’ve got to have a good accountant and you’ve got to tell the truth.

Quite reasonably- partners can get quite tetchy about you using practice staff to help run your clinic; so for instance, you have to agree a sum for using the practices appointment system for your private patients.

I think the men I see in this service need especially careful and sensitive handling- so the way I work it here is that all the phone calls come through on a separate dedicated line which is handled by a research co-ordinator we have in the practice- and I reimburse her separately.

Correspondence is very important. I hate it when it’s slow and she handles all that as well.

This service has just sort of evolved and I like the fact it has- I would advise anyone not to get too big too soon.

Of course as GPs we’re not used to charging our patients and it can be a horrible feeling. But in my experience- and I recognise this might be particularly true of this group of patients – most guys are happy to pay to get treated for a problem that’s simply not well served by the NHS.


“It’s quite a hefty investment and I’m not sure I’d do it this way again”

Dr Paul Steventon set up and runs a private skin clinic in Epsom, Surrey -Forever Young Medical Aesthetics.

When the micromanagement of QOF was introduced I realised I had become quite despairing of working fulltime in NHS general practice and it just wasn’t the direction I wanted to be going in.

But burnout is a state of mind and I decided to branch out into different areas. I worked on developing the Doctors Independent Network but also started to do some skins and did the diploma in dermatology at the University of Cardiff.

That in turn sparked my interest in setting up the skin clinic- despite having no particular specials interest in dermatology before. I’ve never done anything by halves and realised early on I wanted to develop a service that was run to a very high standard, in a stand alone building, offering a fairly wide range of procedures.


41268863Setting up the clinic for scratch was a huge undertaking. Firstly I had to find premises and the criteria for a locating a clinic like this is very different from general practice. You want somewhere easy to find but which ladies can enter and leave fairly discreetly, so eventually found our current building just behind the high street.

I also realised at the beginning that one way to get the most of the new venture was to make it very much a family business- so my two step-daughters work her as beauty therapists and my stepson manages the business.

At the moment I do sessions here but I also employ two other salaried GPs.

We have a lot of repeat business and I think that’s key. I made sure we developed a reputation for doing what we do well so ladies keep on coming back to us. There is an awful lot of poor, unregulated practice out there and I realised early that even plastic surgeons aren’t great at doing procedures like Botox and fillers, which forms the core of our business. But we’re also do minor surgery and some lower work such as liopsculpture. Hopefully we’ll also soon be able to offer treatment for hyperhidrosis of the axilla.

It was a hefty investment and I’m not sure I’d do it this way again if I had my time over. It’s not a goldmine and I haven’t been able to draw a hefty salary from it. But the initial investment has been paid now so we’re moving into profit and, more importantly, I’ve got a successful business I can hand on to my family.

But where it’s really paid off is in personal satisfaction. My weeks are very busy but very enjoyable. About half of my time is spent at the skin clinic, the rest in general practice and I also do some hospital practitioner work.

Setting up this business took the pressure off my increasing disillusionment with NHS general practice- which I now enjoy much more than I did when I was full time. I had been frustrated and probably had become mot as food as the job as I had been. My self-esteem has certainly gone up.

Edwards steventon

Image: Stefano Valle /

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