Moving from NHS to an Independent Podiatry Business

Whether you are starting your business following graduation or transitioning within the podiatry sector, there are several red flags to watch for. We should refer to them as green flags to counter any notion that independent practice is something to be avoided. This article looks at clinical practice from a static base rather than a domiciliary practice, although there are principles that overlap. Naturally, in such a short space, it is not possible to cover every aspect.  More resources can be found at the end.

Which business?

 The Accountant

Business decisions come in two varieties: Sole Traders or Limited Companies (Ltd.) Unless you are already making a decent income, making your business limited too soon is expensive and requires more bureaucracy because accountants submitted have exact requirements and preparation. No matter which you might select, an accountant is essential to guide your business.

The change from PAYE as in the NHS or other employment will require you to pay His Majesties Revenue & Customs (HMRC) each year. If you are moving across from PAYE (pay as you earn) to self-assessment, then steering your way through the maze is essential. Some methods legitimately save money, but being savvy is necessary. Your accountant will offer the correct techniques, from car purchase to use of home, mileage, purchase of equipment, and depreciation.

Location

• Where should you practice?
• Home, rent or buy?
• Rural, or urban or mixed?

Irrespective of these choices, you will need to check if you are allowed to run a business from that address. The advantages of using a home are plenty if you have space, adequate parking, and don’t mind the cross over with people knowing where you live or seeing your family. You will need to check with your mortgage lender if the use of the home contradicts their terms.

Renting is a good place to start, but of course, you have to cover your costs. No income means you are running on an empty tank. If you go in with another professional—osteopath, physiotherapist, dentist, and there is room, the passing clientele will see you whilst attending for another appointment. Visibility is more or less the key to growth.

Some private hospitals rent out rooms and support services like podiatry, and this option may be worth considering. Good visibility, support, and professionalism are essential. You pay for the rooms only as needed, but of course, there may be a minimum requirement.

Buying a location requires a lot of money, and if you don’t have the funds, look elsewhere. Buying goodwill from another person is an option, but it has pros and cons. If you can afford a property, you will build value, but when sold, this accrues capital gains. 

For many, starting a business means working across several environments. Retaining an NHS part-time contract allows income flow while trying to establish a new business. Although stated at the top of this article, the use of a domiciliary outlet offers some start-up benefits. At the same time, you build your clientele, but if you want to practice the broadest scope, domiciliary is limited to essential foot care.

Hidden costs

Depending on your goals, practices can be expensive to set up and operate. Sharing mitigates some of that expense. If you lack start-up funds, you will need to lease, hire, or take a loan for autoclaves, sonic cleaners, couches, clinical units, lighting, instruments, stock, and dressings.

Health & Safety cannot be ignored, as there are fines for not taking care of waste. Suitable sinks and drainage are essential. Protective clothing (PPE) and first aid are required, along with fire prevention and management. Taking this all into consideration, you will need insurance against accidents. This is where using professional indemnity may be best to use a policy offered for podiatrists or foot health practitioners. Do not confuse buildings and contents with other insurance. In addition, it is essential to have practice indemnity covering at least five million for regular podiatry practice, more for higher risk.

All graduates wishing to use their professional title of podiatrist have to pay a fee for registration to the Health & Care Professions Council (HCPC) of £116.36 a year, reduced in the first two years for new graduates. Those registered under the HCPC can incur additional legal costs when defending a case brought to the HCPC. Barristers are required for some claims, and a case of proven negligence can end a career.

 An essential list requiring annual fees.

• Buildings & contents.
• Public Liability.
• Malpractice & legal costs.
• Motor insurance for businesses should be added to your regular car insurance.

Other hidden costs

• Continuous education & professional meetings.
• Online courses & building your library.
• Holidays (essential for health).
• Sickness provision. Once you are self-employed, this falls to you.

 

What style of podiatry?

Your role is to manage people and their foot health, so you should always practice to the best of your ability, no matter what sphere you intend to work in. There is a balance between making a living and existing to cover your outgoings against a desire to practice in one field alone. Essential care, often called maintenance or core podiatry, will always pay the bills. Trying to set up as a specialist is rather tricky without a previous base and the right to specify that you are a specialist. It is essential to ensure training is continued, and this has to be funded.

The practice of high-risk care is less attractive in the independent (private sector) sector, although there is nothing wrong with developing a practice prepared to provide such a service. However, the higher litigation risk of this type of care might limit what is offered. As one matures and gains experience, specialising is rewarded, but it does not happen overnight. It is unlikely you can offer the complete care provided by the NHS depending upon the affordability of resources required by your patients.

Orthotic work is part of a podiatrist’s role. You can set up a room with a grinder for limited provision, but using external laboratories avoids some of the high set-up costs and health and safety concerns. Selling over-the-counter products can be valuable. Your competition is the Internet and high-street outlets such as sports shops and pharmacies. Nail surgery is not a specialty since all podiatrists are trained in these procedures. The problem lies in confidence and setting up the additional conditions needed to deliver this treatment. Where podiatrists do not provide nail surgery, this does offer the newer graduate an opportunity to close any gap.

Paediatric podiatry provides a limited service but is essential and should be part of every practice. Traditionally, this came under a wart provision service, but MSK and advice should rank highly. More about advice and education in a moment. Sports activities can attract patients to any practice, depending on your brand, reputation, and interest. Offering advice and attending local dance sessions and football games can enhance your name, but much of the start-up may have to be delivered gratis.

Your primary role will be dealing with the skin and having a good knowledge of dermatology, where screening is essential, and tissue preservation is key. This brings us back to education and advice. Using aids and providing talks to outlets cannot be underestimated in terms of the power of advertising your services. Quality foot health material can be purchased or made for this purpose as giveaways. A skeleton (plastic), foot model, and basic anatomy charts are all part of the educational scene.

Target Audience

Know the audience you want to reach, as well as the location and community demography. Poor areas with high unemployment will lead to slower growth than areas with good industry and more expensive housing. These are facts, and naturally, our services should reach all potential clients. As the NHS podiatry services continue to shrink, it is unlikely that you will not attract growth. Visibility is essential, and you will need local medical surgeries to be aware of you and what you can offer. GPs are under enormous strain due to delays. Fill this gap and use your medical skills to guide a quality consultation. Give talks to local GP practices.

Your brand is you, but consider representing this with a logo and caption. Be creative, and set up a website. While these are expensive if designed by others, you can develop your own with time and patience using outlets such as Wix.com and WordPress. Advertising is not always cost-effective, and money is limited in the early days. You can invest in small posters for locations that are willing to allow placement. Word of mouth, based on reliability, is essential. Finding a local-friendly printer can be helpful, or you can use some online print-on-demand services. 

If you decide to work with an established practice as an associate or partner, your growth may be faster than starting from scratch. Social media has become the watchword; where it is free, it can be invaluable but time-consuming. Canva offers a way to build attractive images for promotion. The percentage of income from such an effort may be less than hoped, with everyone using the same platforms, but it gives you visibility.

Competition

There will always be competition, and your only asset is that you can offer a faster appointment, depending on your location.  An older population in retirement offers a client-patient base for the standard ranges of podiatry and foot health care compared to younger populations. However, never underestimate those under retirement age, as there is little NHS provision outside their strict criteria. Fill in gaps with domiciliary work, especially in rural areas.

Set your fee structure sensibly. Cover your costs (see the list of some of the items above) and ensure you have a profit margin. You are a business, not a charity. Be creative and offer services others do not. In a dense marketplace, offering some services at no cost can increase exposure and loyalty to existing client patients, but be careful to balance this approach.

Availability

One of the biggest problems any practice has to overcome is access availability. Too many have full books. People want to speak to humans, and using a telephone, although more so with a smartphone, maybe the only way to solve this problem, other than a physical receptionist. Once you employ someone, you have to consider all the paperwork, employment requirements, and costs. Having someone to capture your patient’s requests 5-6 days a week in person is essential. These services can be hired. Many use their websites for patient appointments, which is efficient, but answering phones to leave messages is a big turn-off.

Those entering podiatry and inevitably qualifying will gain a thirst for one of the many opportunities. Older graduates with families have a different imperative than younger graduates who have no dependents. Careers are built over time, effort, motivation and patience. Going into self-employment alone is not for the faint-hearted because growth will take a number of years, hard work, and potentially long hours. Spreading your employment across different opportunities pays the bills, but at the end of the day, you have to enter what has always been known as a private practice with eyes wide open.

Resources

You should do as much research and reading as possible before embarking on independent practice. The leading professional bodies, such as the Institute of Podiatrists and the Royal College of Podiatry, produce and support independent practice. OSGO is slightly different. It is set up to offer comparative services stylised toward business.

Gurus—Everyone is an expert these days, and cynism is an in-built defence mechanism as many have set up a business to help podiatrists. While this article cannot judge their value or refute the value of such services, it is recommended that you attend conferences and local meetings and discuss the business of practice before spending money on a lengthy course with a sizable price tag. With so much online advice these days, if you have the time, listen to free webinars, many of which can be found on common sites such as YouTube. 

Attending conferences is vital for learning more about your business, which is what independent practice is—a business. Networking with colleagues is also important. The following books are available through Amazon. There is a surfeit of marketing books that offer helpful guidance. Look at the reviews and star ratings where available. Not all books are helpful, and some drive you to the guru experience.

 

Learn About Your Profession ~ booklist.

Voices From Podiatric Practice (2023) Tollafield, DR. Hardback £30.25, paperback £9.99 & digital £4.99 provide a rare insight into all the specialties and outlets with helpful stories in how each podiatrist set about their career. 388p. (UK)

 

For lighter reading, Podiatrist on a Mission takes you through a young podiatrist’s experience and employment and explores the different mediums available with stories about patients.

Podiatry and Other Authors 

(Note: The books below are not necessarily being recommended, but a showcase is available. You can check your professional organisation for further material.)

A Guide to Setting Up and Running a Successful Podiatry Practice. Flanagan, T. (2015) Paperback £49.99 Kindle £9.99. 366p. (UK)
The Podiatry Practice Business Solution. Wishnie, P. (2019).  Hardcover £19.99. 174p. (US)
Podiatry Business Secrets. Donaile, LO. (2020) Digital £8.47. 129p.(Eire)
Podiatry Prosperity. How to Market, Manage and Love Your Practice. Jackson R. (2019). Paperback £13.59. 140p. (US)
Podiatry Profits: Crafting a Seven-Figure Lifestyle Practice. Ahn, TJ. (2024). Paperback £15.00. Digital £7.99. 175p. (US)
It’s No Secret…There’s Money in Podiatry. Franklin, T. (2014). Paperback £14.99. Kindle £10.99. 230p. (Au.)

Thanks for reading Podiatry Business From Scratch

I want to express my thanks to private practitioner Gaynor Wooldridge for her assistance and advice on this article.

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David is a retired podiatrist with experience in hospital private practice, orthotic manufacturing, and working with both the NHS. His autobiography, Podiatrist on a Mission, includes his experience setting up a practice in the UK with his wife as a general practitioner. He is now a full-time author of health books and fiction.

 

ConsultingFootPain is a free resource. Published by Busypencilcase Communications Est. 2015