Business cycles of a private practice

In the first of a two articles, medical billing and collection expert Simon Brignall examines the life cycle of a private practice during a consultant’s career. Here he provides some useful advice for consultants starting out on the independent journey.

We are all subject to the impact of time, and businesses are no different. 

Every business goes through four phases of its life cycle: start-up, growth, maturity and renewal/rebirth or decline. 

Private practice is, in fact, similar to any other small business, so understanding what phase you are in can make a huge difference to the strategic planning and operations of your practice.

As part of my role, I often meet consultants whose practices are at each of these various stages and so I thought it would be beneficial to discuss the challenges they face and how these can be overcome.

Starting out

One of the most common things I hear from consultants when they start out in private practice is that they suddenly feel that they are on their own. 

There can be a sense that they are no longer part of a team and that they are left to fend for themselves. They feel colleagues who they went to for medical advice may be reluctant to assist them.


There can be a lot to consider when you are setting up your private practice and so here is a short check list of subjects to tackle to make sure everything is covered:

 Accountant – to advise on being a sole trader/limited company/ LLP;

 Bank accounts;

 Private Medical Insurer (PMI) recognition;

 Staffing/administration;

 Infrastructure;

 Marketing and digital footprint;

 Medical indemnity.


It is always advisable to sit down with an accountant to discuss your plans, as they will be able to provide you with their professional opinion about what corporate structure would be beneficial for you. 

At Civica Medical Billing and Collection, we have practices of many types, including sole traders, limited companies and limited liability partnerships. 

Your personal circumstances will dictate which is best for you and your accountant will also advise you of the reporting requirements for each option. 

Bank accounts

I would recommend having a dedicated bank account for your practice’s funds, as it makes the reconciliation task easier and means you are less likely to have errors. 

If you are setting up your own company , then this will require a dedicated company bank account. Please note we have noticed the banks have been taking longer to do this since the pandemic, so ensure you prioritise this task.

Private medical insurer (PMI) recognition

Depending on your specialty, it is likely that private medical insured patients will make up a significant cohort of your patient demographic. So you can see why gaining recognition is important and needs to be actioned as soon as practical. 

Note that the PMIs will require your bank details as part of this process – which is why it is important to ensure you have reviewed the points on accountants and bank accounts.

The Private Practice Register (PPR), available from Healthcode, enables you to get set up with multiple insurance companies in one go. 

Here is a short list of the major UK PMIs you need to be set up with.

 AXA;  

 Bupa; 

 Aviva;

 Cigna;

 Healix;

 WPA;

 Vitality Health;

 Allianz.


My advice to any new consultants starting private practice is to ensure they focus on growing their practice and treating patients. 

It is important they ensure the billing and collection is quick, accurate and efficient and that they offer the full array of payment options patients expect.

As new consultants face an array of fixed costs such as their medical indemnity premium, medical secretary fees and possibly practice management software, this means there is a distinct advantage in choosing to outsource their billing. 

This is because most billing companies’ fees are calculated against money received and often billed in arrears. That can be a welcome relief to the practice cash flow at this time and ensures some of your costs are aligned to your income.

Splitting the medical billing from the many other tasks your medical secretary carries out is also beneficial. 

Choosing to separate the billing process from the patient’s clinical journey allows your medical secretary to maintain a warm and engaging relationship with the patient because they are no longer required to make those difficult segues into conversations about money. 

And by removing the burden of the billing process, this allows your secretary to respond to any new inquiries or patient queries more effectively, which, in turn, boosts revenue.

Recruiting for a medical PA to carry out the remaining tasks is often easier, as many medical secretaries do not enjoy the billing and chasing tasks and you will also have the capacity of the billing company on tap to accommodate the practice as it grows. 


One of the first things consultants should do when commencing private practice is to ensure they have the appropriate infrastructure. 

A vital element of this involves having a robust auditable system to facilitate the financial processes of the practice. This should include the ability to:

 Raise invoices and take 24/7 payments;

 Reconcile payments;

 Employ a robust chase process, including the ability to follow up on outstanding invoices using a range of communication methods.

We use our own proprietary software so that even practices we partner with who rely on manual systems now have the infrastructure and functionality of a modern practice. 

Effectively, they have the revenue management side of a practice management solution alongside the latest payment pathways.

Whatever system you adopt, you need to ensure the billing for the practice is auditable and accurate so that figures can be easily generated for your accountant 

Marketing and digital footprint

It is important to review your presence online and ensure that whatever you find puts you in the best light. 

Even if you do not have a website, you will find that you are probably on multiple sites, which may include the hospitals you work and your Bupa profile. 

Make sure the information displayed is up to date and ensure you have a professional profile picture. Many studies show patients are more likely to engage when there is a picture of a person they can relate to. 

Where possible, and this especially includes on your website, remember your audience is prospective patients not your colleagues. 

Tailor your messaging to your patients’ needs rather than attempt to impress your colleagues by detailing your CV or a list of your accomplishments.  

Medical indemnity

You will require medical indemnity cover for your practice activity, and this can be sourced either from the commercial insurance market or one of the medical defence organisations (MDOs). 

They will offer cover based on ‘losses occurring’ indemnity or ‘claims made’ insurance policies and contractual and discretionary indemnity. 

It is important you understand these terms and assess which option is best for you. 

Starting out can often be the most daunting phase of the practice life cycle, as everything is new. 

Often the best option is to reach out to experts such as a medical billing company, who can not only provide valuable assistance in this key role but can often assist with introductions to key providers in other areas.  

Simon Brignall (right) is director of Business Development at Civica Medical Billing and Collection