Private medicine is rewarding on many different levels and consultants will enjoy an environment that provides control over their practice.

There will still be pressure, but working with a responsive local management team can make things easier.

Many doctors will work with an independent healthcare provider, often dictated by the proximity of the hospital or clinic rooms for convenience.

But to gain practising privileges at an independent hospital or clinic, a successful application process with a continuing commitment to governance is expected.

Mr Adrian Chojnowski gives some thoughts on that journey from his perspective as a consultant orthopaedic surgeon and chair of the Medical Advisory Committee at Spire Norwich Hospital.

1. Engagement and networking

The local hospital director is responsible for the safety of patients and will ultimately decide whether to grant practising privileges. So arranging a meeting will be the most important first step.

You will need to gauge the local need for your specialty/practice intent and if it can be safely supported by that hospital or clinic through, for example, equipment needs or staff training.

Consideration must be given to any colleagues who work in your area of expertise, not least to arrange for cross-cover.

Reasonable colleagues will be supportive of your start-up – they all had to do this once themselves, so start networking.

A supportive group of doctors who can help each other with advice or in a clinical emergency, is without doubt a safer proposition than a lone clinician.

2. Admission pack

Spire Healthcare publishes a Consultants Handbook, which should be read thoroughly and outlines your responsibilities alongside those of the hospital to support your patients.

It will form part of an admissions pack that will need to be completed with, for example, suitable medical defence cover in place.

The hospital director will consider the formal application and may take advice from the medical society – consultants who practise at the hospital – such as specialty representatives and the medical advisory committee (MAC) via its chair at the hospital. All being well, you are now a member of the society.

3. Practice set-up

Communication is key and you will need to engage with several hospital teams.

If you require access to theatres, then flexibility at the start, reliability and forward planning are essential.

Managing your lists well by booking suitable surgical times for your cases and clear instruction on equipment needs helps build a good relationship and establish regular slots.

Similarly, working with clinic and invoicing staff helps your practice grow smoothly.

4. Good governance

Good governance is paramount for the independent provider, your practice and your patients. For every consultant seeking practising privileges at a Spire hospital or clinic, they must be listed on the GMC medical register and undergo a thorough vetting process.

You will be expected to work to guidelines set out in the Medical Practitioners Assurance Framework (2022 refresh). While you are responsible for clinical decision-making and the quality of the care you deliver to your patients, the hospital is responsible to ensure systems of monitoring and oversight are in place and adhered to.

This is designed to ensure that all consultants practise in accordance with Spire/hospital policy, and in line with their practising privileges.

All consultants must maintain adequate minimum levels of medical malpractice indemnity cover, in keeping with GMC guidance, and comply with Spire/hospital checks to ensure that indemnity certificates are in place.

There is an expectation that medical practitioners share their activity and outcomes data with independent providers through the annual appraisal process. You will need to put your cases on any national registries to help provide data on quality.

5. Maintain probity

Defined as ‘honesty and decency’, you must aspire to the highest standards in keeping with the GMC’s Good Medical Practice. As well as complying with Good Medical Practice, there are other obligations about openness with patients to comply with, such as the Competition and Markets Auth-ority requiring fees to be transparent to patients.

Set your rates, but be clear in advance with patients what these are and what they will receive in return. Fees must be communicated to The Private Healthcare Information Network (PHIN).

Coding your cases must be transparent and honest. Patients are under the care of the private provider, so any equipment you use must be agreed or provided through the hospital which will help maintain the highest standards.

6. Build your service

Build your service with the hospital by talking to your business development manager about advertising or GP education sessions.

Never criticise staff if you do not have the right drugs or equipment – what did you do to plan your service and discuss equipment in advance?

If the hospital is at fault, do the best you can before providing constructive feedback, which any member of the senior management team should respond to so that the issue is not repeated.

7. Practice review

Expect your practice to be reviewed at least every two years alongside details of the range of procedures you carry out. The hospital director and specialty lead from the MAC conduct this and, for most consultants, it is a straightforward process.

8. Deal with complaints

Sadly, these do happen. For example, a self-pay patient reasonably wants to feel they have had value for their new patient consultation fee.

A simple diagnosis and plan delivered in a few minutes will leave a patient feeling let down, so spend the time of the consultation with them to ensure a good understanding of the problem.

If complaints are received, many will be made to your hospital, so early and constructive engagement with your hospital team is important. You are in it together.

9. Prepare to serve

Consider stepping up to join the governance or medical advisory committee at your hospital, which you will find rewarding.

These should be suitably resourced and you will feel that your advice is taken and acted upon, helping maintain a safe environment for patients and staff.

10. Enjoy

The above may all sound quite a lot, but once you are up and running, it is worth reflecting on the time you can spend with your patients and the high quality of care being delivered and the positive impact it is making to their lives.

It is in your hospital’s interest for your private practice to operate well and, as an engaged, reflective consultant who is easy to communicate with, you should be easy to support.

Spire Healthcare works in partnership with over 8,600 experienced consultants. The group delivered tailored, personalised care to over one million inpatients, outpatients and day-case patients and occupational health programme clients in 2023.