Dr Heather Ryan on setting up a private GP practice in a bid to provide an ‘ethical’ service to patients and free up NHS appointments
Until a couple of years ago, I had never seriously considered working in the private sector. I had gone straight from GP training into partnership when I qualified in 2017. But the Covid pandemic, along with a relocation back to my home city of Liverpool, prompted a change of pace. Both my husband John – who has been a GP since 2004 – and myself left our partnerships and found ourselves looking for a way of practising medicine sustainably and providing good quality care.
The expansion in private GP services is a consequence of the decline of NHS general practice, not the cause. Many GPs are leaving the NHS, or reducing their working hours, because NHS general practice is now an incredibly difficult environment in which to work. There is a ludicrous mismatch between what politicians expect of general practice and what funding they give it.
We identified a gap in the market for an ethical, high-quality private primary care. Many existing private practices seem to target healthy young people by offering non-evidence-based screening, aesthetic interventions, and other questionable treatments such as IV vitamin drips. Instead, we decided to operate much more like a traditional family doctor, offering patients unhurried face-to-face care, and only arranging tests and treatments if clinically indicated.
Unfortunately, we encountered a backlash when we opened Formby GP in January. We paid for advertising on Facebook, including on a local community page, and that elicited angry comments: some accused us of being part of NHS privatisation, while others suggested that we were greedy and should increase our NHS commitments. One commenter even joked about running us over with his car.
I understand why people are worried about the growth in private GP services, especially if they can’t afford to pay for private care. But our intention is not to undermine the NHS; patients who see us are not attending their NHS GP surgery, so, if anything, we are taking a bit of pressure off practices.
As former NHS GP partners, we felt strongly that our service should not create additional work for NHS GPs, so we worked with our LMC to ensure that we were set up to do our own referrals and paperwork as much as possible. Private GPs are entitled to refer into NHS secondary care – the entitlement to NHS care rests with the patient, not the referrer – so we do our own referrals rather than bouncing patients back to their NHS GP.
Opening our own private practice has not been a straightforward process. It took us several months to find suitable premises, and then several more months and tens of thousands of pounds to refit those premises to meet the necessary healthcare buildings specifications.
In terms of finances, we have funded the project entirely ourselves, without external investment. This felt important to us so that we could maintain our independence and set high clinical standards. I still work part-time in the NHS, as a GP in secure services, and that income pays our personal mortgage and living expenses. Meanwhile, John does some locum work through our limited company to help with company cash flow.
We have loaned the company a significant amount of our own money. As a result, we share one old second-hand car between us, and we don’t have as many holidays or gadgets as most of our doctor friends. There is a common misconception that medics go into private practice for the money, but, in the short-term at least, we would have been better paid if we had stayed wholly in the NHS.
We’ve been open just under five months now, and it has been wonderful. Having time to get to know patients and their families properly is an absolute joy. Before we opened, I worried that we might spend our working days saying no to patients inappropriately requesting antibiotics or scans, but it’s been quite the opposite: I feel like I’m picking up serious pathology at a higher rate than I did in my NHS GP partnership, and, at the risk of sounding trite, I really feel like I’m making a difference to my patients. Our patients seem to agree. So far, feedback has been overwhelmingly positive. We have already picked up cancers, co-ordinated end-of-life care, averted admissions, and formed strong working relationships with the local district general hospital and hospice.
Given that neither of the major political parties has a credible GP rescue plan, I suspect that we will not be the last doctors who look for a means of escaping a broken system – and I hope, for the sake of patients, that the powers that be find a way of ensuring that patients who cannot afford to pay for their care do not get left behind.
Dr Heather Ryan is managing director of Formby GP, a private GP clinic in Formby, Merseyside
READERS' COMMENTS [26]
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Fantastic – good for you! Well done. What a lot of hard work. I hope you are super successful. All the best 🙂
Good on you for trying!
Several patients tried to persuade me to do private GP services when I left a Practice back in 2004, and again later.
I did some careful sums, and worked out that it was unlikely by far that there would be sufficient locals able to pay a suitable rate, leave alone willing to pay a suitable rate, back then, considering the set-up costs.
Nowadays the chargeable rate may have gone up significantly, because of difficulties accesing NHS care, but the set-up costs have also massively increased. My income security situation would allow it, but the personal financal investment needed is not worth the risk.
Of course you were being greedy – if you were not offering it for free! Look how little people appreciate what they can get for free, or the costs of others’ time. They will have simply assumed you would take out profits in line with other private healthcare companies’ CEOs, of course.
I’ve been out of the rat race for 6 years and no axe to grind. That being said a private GP service has been a long time coming. May you be the first of many, many, more. To the rest of the great British unwashed I say “Wake up and smell the coffee”. The Government seriously underfunds the NHS and the GP service in particular. Private practice needs to be an option.
To each their own. But please call it what it is rather than sugar coat it.
I work 4 days in my NHS surgery and one day in a private sector. The pay in private sector is not fantastic and the service is crap, but job satisfaction is immense. What’s expected from me is appropriate, realistic and nearly risk free. It taught me to appreciate how much I put myself out for my NHS service for very little additional material gratification- certainly not worth the effort. There’s no doubt that my NHS patients get far more of my time and expertise, but it’s the private ones who are really grateful and appreciative of what I do within a very poorly delivering system. I bet something to do with psychology of transactional agreement. Spin this how you want, but I am convinced that charging NHS patients a small fee for every appointment would result in massive change in attitude.
Dr Ryan, well done, and best of luck.
Not sure I know where to begin here. I retired from Practice in 2019 due to the all the issues that you have described. Never once did I consider private practice. Does it not seem odd that you accept the NHS TRAINING at a very cheap price and then abandon the system to charge the patients who paid for your training in the first place? As for freeing up NHS appointments and trying do not bother the poor NHS GPs with any extra work who are you trying to kid? In America you pay hundreds of thousands of dollars to become a Doctor and then the insurance companies basically pay your wages not saying its right but at least its honest.
James Bissett, you really think that UK trainee Doctors, including GP trainees, rip the benefits of overgenerous system? Really? They are essentially cheap labour for the NHS, occasionally getting some protected tutorial time – mostly in GP surgeries.
I recently said goodbye to another batch of medical students. They enlightened me that as far as clinical placements go, GP placements are the only ones where they have some continuity of supervision. In hospitals it’s new face every week and nobody cares. I know which one of them will pass finals, they know that I know. In hospitals they get- who are you?
So, yes, if people accept that kind of NHS training and turn out to be acceptable GP, I fully support them with whatever choices they wish to make. They are still going to repay their student loans. Sure, realism if American system should scare us all into accepting whatever, but do you really wish that kind of healthcare to be here?
Suggest you get off that moral high ground you don’t belong to and try to widen your views or at least try to understand that people, including doctors, make their life choices for various and often complex reasons.
Well done the pair of you. Being pioneers will always attract people who try and see the negative.
This is the future of general practice, people will pay to get a proper service.
James, do you have similar issues with Vets and Dentists? Or is it just doctors who have a compulsory “vocation” thrust upon them?
Brave venture and hope it works out.
Are you able advise the Practice’s scale of fees?
Slippery slope.
Private medicine is not going to fix things for most people who live in this country and the idea that creeping privatisation does not undermine the NHS, and might improve access for NHS patients is in the long term just pure fantasy. All this does is mark out some of the deckchairs on the Titanic as ‘for paying customers only’. It does not create more deckchairs, probably the reverse.
What used to work, but has been cruelly and deliberately broken – especially over the last 13 years- is now bearing fruit for right wing ideologues. Bevan was right all those years ago, although I think he was a little unfair on the ‘vermin’ he used for comparison.
Inequality and a much poorer society for all of us can be the only result of this fragmentation.
Unfortunately the NHS is elevated to sainthood by many. Yes, the idea of free healthcare for all is wonderful, but it ignores human nature and that things that are perceived as free are not valued. A good portion of my NHS work time is wasted on issues which any competent adult should be able to manage and the ‘can’t be too careful’ collective. The rest of my time is spent scrambling trying to fit 20 minutes worth of medicine into 10 minute appointments. Many of us keep our sanity by reducing sessions, so kudos to you for finding an alternative that works for you.
Well done.
Dont worry what others say.
Patients want time, this is what is on offer- for a price.
The real test is will the business wash its face- if yes, the risk you took has paid off and the “customers” value what you are doing.
Since I retired we set a Ear microsuction service- 3 years in, going really well, 2 franchisees opening up. Great fun, impact, 30 min appointments. Some practices “use” us as screening service for Ear problems- see them first and then return if “medical” problem.
There is real demand for quality time out there and navigating NHS system, that is what some of our appointments really are.
General Practice is changing, this is one part of the change.
Hi Keith. Our fees are summarised at http://www.FormbyGP.com/prices
Well done
Currently not worth signing up for partnership.
Well done for trying an alternative and exiting from the current purposefully managed government dismantling of primary care in front of the public’s eyes. Ignore the patient critics – it is for them to lobby their MPs and demand a properly resourced primary care service.. GPs have been raising the alarm for the past 15+ years with very little support or sympathy from the public. Do what you have to do to practice safe, effective medicine.
Good luck.
NHS GP squanders huge sums on nonsense, demise long overdue.
Wow. James Bissett. Maybe you’re forgetting the 1-in-3 rotas and 80 hour weekends. Maybe you’re forgetting the most we got paid for a night visit was £45 – and that quickly got slashed to £20; you couldn’t get a plumber to fart for that. Maybe you’re forgetting the over work and terminal taking of the **ss by successive governments of both parties.
I don’t believe private practice will be lucrative; but it is undoubtedly taking hold. Easier to get a virtual private consultation than to see one of the dwindling number of poor GPs.
Good on these guys for actually getting out there and trying to take control of their destiny. We could do with more of that.
And forget the BS about “free” training. I paid for mine several times over thanks very much.
James. The majority of graduates in the UK work in the private sector sometimes earning more than a medic. And nowadays students pay an amount similar to that at a US state university. And of course they provide their services at a discount for 5 to 10 years post graduation.
Can someone explain why Pulse is restricting posting comments to GPs only?
Once the compulsory salaried GP service is introduced, I would expect the private sector to expand exponentially as GPs leave in their droves.
Wish every success in your venture! I hope many more GPs will follow. Carpe Diem. If the politicians don’t/won’t listen, then it’s time to carve out a new way of doing things.
The headline writer is being a little disingenuous here – “in a bid to provide an ‘ethical’ service to patients and free up NHS appointments”. Nowhere in the actual article does it state that one of the aims was to “free up” NHS appointments. A private appointment might or might not mean one less NHS appointment. I suspect it would be very difficult to prove for sure. But someone actually saying that they went into private medicine *for the good of the NHS* would have to have a pair of gonads the size of Liverpool.
Doctors can go into private practice if they like. It’s their business. Articles like this trying to justify/explain seem a little pointless.
FWIW, IMHO, tax-payers (and thus the representatives they elect) simply don’t want to pay for the kind of NHS they say they want. Everything for everyone all the time, with no waiting lists and a huge smile from everyone.
As I have said for many years, all the government really has to do is to change the one rule that says NHS GPs cannot charge their NHS-registered patients for extra/added services. If they made that one simple change, it would unlock a whole new tier or two of voluntary co-payments that would (a) make the service much better, (b) bring a lot more doctors into general practice and (c) keep a lot more current doctors IN general practice.
But no, the cult of the NHS is powerful, and even as the quality of the NHS drops lower and lower, those who believe in it will cling to it more firmly, holding fasts to the masts of the vessel as she sinks inexorably.
I’m a GP trainee. This is perhaps one of the most inspiring things I’ve read about General Practice recently. I am happy to hear that there is an alternative pathway that isn’t just about injecting botox. Well done for setting this up and wish you all the best for it!
As for the comment about the NHS paying for my training, I have just worked 3 A+E weekends in a row for under £100 per day and not had a minute of teaching time in the process. Wonderful, isn’t it? My colleagues in Australia are laughing at me. The NHS trains dentists, podiatrists, nurses, midwives, pharmacists, dieticians, physios, plus many more who go into private work. Why is it a sin for doctors to?
1 Understand what business you are in. It isnt health. A lot of what we do and what causes burnout is more “consumer service” demand than “health need”. The market delivers much better than the public sector in consumer services.
2 Charging for a convenient efficient service may not seem heroic but might pull in much needed resources and burn out less colleagues.
3 It might limit some of the nonsense. Think of the 5p bag tax.
4 Another chunk of our work is political whim/ NHSE red tape. We chase around to to keep civil servants happy. Nothing delivers this well. As long as we stay dependent on NHS income we will be at the whim of every stupid ill informed new initiative and target from NHS or Darzi.
Some colleagues seem to be confused about what they actually do. Confused about What their job actually is. When you hear some of them talk you’d think they were working for the Red Cross or MSF. An affliction with the saviour complex or a martyr complex or both.
Good luck with your endeavours. Do what works for you and makes you happy. There is always that cohort that likes to drag others down. The Brits love their tall poppy syndrome.