Medical: NHS Vs Private - Which should I choose?


When embarking on your career as a doctor there are many options ahead of you. Of the roughly 300,000 doctors registered in the UK approximately 62,000 work within a general practice setting with the rest spread across hospitals, medical education, research, prison medicine, management, the list goes on. 

Of those, the majority work primarily in the NHS, with those who work privately often on top of their NHS commitments. A small proportion work purely private.

If you choose to work as a locum you can work in either in NHS or Privately and you can be employed in various different ways –  

There’s a lot of information about the pros and cons of NHS and Private work so let’s look at some of the advantages and disadvantages of working in each sector.

NHS Work

As a recently qualified doctor in the UK, the NHS will be your foundation to demonstrate your competency.  Let’s delve into the pros:

  • Structured training years to ease you into your work as a doctor
  • Greater career options and job security compared to
  • Patients provided to you
  • Healthcare more accessible to a larger demographic
  • Holiday entitlement, sick pay based on length of service, maternity/paternity/shared parental leave, NHS pension, ill health retirement benefit, death in service benefit, NHS discounts

Now let’s look at the cons:

  • Occasional long or unsociable hours
  • Need for geographical flexibility – it’s sometimes necessary to move around to take up jobs in different areas of the country
  • Necessity to work in line with NHS procedures/timescales/targets that could affect time with patients
  • Limited by NHS pay structures

When can I begin working privately?

Once you are fully registered with the General Medical Council (GMC) you are entitled to set up in private medical

As a consultant looking to complete private work alongside NHS you are contractually obliged to offer additional programmed activity to the hospital first, otherwise pay progression is frozen.

The pros of this are:

  • Opportunity to work independently of targets and more chance of one-to-one care.
  • Greater flexibility for your working hours and annual leave
  • More time with your patients
  • More training opportunities
  • Potential for better work life balance (including practicing from home in some circumstances)
  • Pay not limited by NHS salary structures
  • Private work typically pays more

However, let’s look at the cons:

  • You may have to apply for specialist recognition (often patients using private health can only be reimbursed fees if using a consultant that is recognised by an insurer)
  • You may need to have held a substantive NHS consultant appointment to be to achieve this
  • Expectations of patients can be higher
  • Loss of NHS benefits. You may have to make your own provisions for sick pay and pension etc dependant on your employment status.
  • Treatment is costly meaning you may only treat certain demographics or those who can afford private health insurance.
  • Financial considerations such as bookkeeping and handling of personal taxation

It’s useful to remember you can balance both NHS and private work in some instances, and you don’t have to choose between one or the other. If an NHS doctor takes up private work alongside their regular role, they will often earn their but you will need to consider the financial implications of this.   

Impact on getting a mortgage?

When looking to get on the property ladder – ultimately lenders need to see that you have enough regular income to cover your mortgage payments after all your expenses

You’ll need to prove your earnings through payslips and P60s if you’re working in the NHS. If you’re self-employed, ideally you’ll need to show at least two or three years of consecutive tax returns, although there are a small number of mortgage companies who will consider lending if your accountant can give an estimate of your whole year’s earnings.  More information is available here

Decision time?

Ultimately the choice is yours when deciding where and how you decide to work.  It’s a big decision and important to look at the pros and cons of each option: tax implications; plans for your career development: your attitude to financial risk and weighing up all the different options available to you.  We wish you the best with your future career and we’re sure you’ll make the right decision for you!