NHS vs Private Practice in the UK: A Doctor’s Comparison
Doctors in the UK can work in the NHS, in private practice, or in a mix of the two. The NHS offers a defined-benefit pension (the NHS Pension Scheme), nationally-set contracts, and state-backed clinical-negligence cover for NHS work; private practice offers higher potential earnings, more control over your schedule and caseload, but variable income and the need to arrange your own indemnity and administration. Most consultants who work privately also keep NHS commitments, so it is rarely a binary choice. This is general information — confirm the current contract, pay and pension terms on the official sources below.
NHS practice
Employment (or a GP contract) within the National Health Service, on nationally-negotiated terms with the NHS Pension Scheme and NHS indemnity for NHS work.
Private practice
Fee-for-service or salaried work outside the NHS — private hospitals, clinics or self-employment — with higher earning potential but self-arranged indemnity, pension and admin.
NHS practice vs Private practice, side by side
| Dimension | NHS practice | Private practice |
|---|---|---|
| Pay structure | Nationally-set pay scales (resident/junior doctor and consultant contracts; GPs via the practice/PMS contract). Predictable and banded. | Fee-per-item or private salary; income scales with caseload and specialty demand but is variable and market-driven. |
| Pension | Access to the NHS Pension Scheme — a defined-benefit (career-average) scheme with employer contributions. | No NHS pension for private-only work; you arrange your own pension (e.g. a personal/SIPP). |
| Clinical-negligence cover | NHS work is covered by state indemnity schemes (e.g. CNST for hospital trusts; CNSGP for NHS GP work in England). | You must arrange your own professional indemnity (e.g. MDU, MPS or MDDUS); premiums vary by specialty and risk. |
| Job security | Salaried NHS posts offer relatively stable, contracted employment. | Income depends on referrals and demand; more entrepreneurial risk. |
| Autonomy & schedule | Rotas, on-call and job plans are largely set by the employer. | More control over hours, caseload and how you practise. |
| Administration | Employer handles payroll, appraisal support, much of the back office. | You (or a management company) handle billing, insurers, secretarial and premises. |
| Route in for an international doctor | GMC registration → apply to NHS training or service posts. | GMC registration (and usually UK experience + practising privileges at a private hospital) first. |
Why most UK doctors are not choosing one or the other
In practice, the common pattern for UK consultants is a substantive NHS post plus private sessions. The NHS post provides a stable base salary, the defined-benefit pension and NHS indemnity for NHS work; the private sessions add income and variety. Private hospitals also typically expect you to have UK experience and “practising privileges” before you can see private patients, so an NHS foundation is usually where an international doctor starts.
That is why, for a doctor newly arriving in the UK, the realistic first step is NHS registration and an NHS or training post — private practice tends to come later, once you have UK experience, a specialty reputation and referral relationships.
The three things people underestimate: pension, indemnity, tax
The NHS Pension Scheme is a significant, often under-valued part of NHS reward: it is a defined-benefit scheme, which is increasingly rare. Leaving the NHS entirely means giving up further accrual, so many doctors keep some NHS commitment specifically to stay in the scheme.
Indemnity also differs sharply. NHS clinical work is covered by state schemes, but private work is not — you must buy your own professional indemnity, and premiums vary a lot by specialty (a high-risk surgical specialty costs far more than a low-risk one). Finally, private income is self-employed income for tax, which brings its own accounting and National Insurance considerations. Budget for all three before assuming private practice “pays more”.
What this means for an internationally-qualified doctor
If you are planning a move to the UK, the sequence is almost always: obtain GMC registration, evidence English, secure an NHS or training post, gain UK experience, and only then consider private work. Private practice is best thought of as something you build toward, not an entry route.
Which is right for you?
Lean toward NHS practice if…
NHS practice tends to suit you if you value a defined-benefit pension, state indemnity for your clinical work, predictable pay and a structured training pathway — and it is the usual entry point for a doctor new to the UK.
Lean toward Private practice if…
Private practice tends to suit you once you have UK experience and want higher earning potential and control over your schedule — usually alongside, rather than instead of, NHS work.
Where to go next
Frequently asked questions
Can an international doctor go straight into private practice in the UK?
It is uncommon. You still need GMC registration first, and private hospitals generally require UK experience and practising privileges before granting a caseload. Most doctors build an NHS or training foundation, gain UK experience, then add private work later.
Does private practice pay more than the NHS?
It can, but the headline fee income is not the whole picture. Private income is variable and self-employed, and you must fund your own pension, indemnity and administration. Many doctors earn most reliably by combining a substantive NHS post (with its pension and indemnity) with private sessions.
Do I lose my NHS pension if I do private work?
Private-only work does not accrue NHS pension. Doctors who keep a substantive NHS post alongside private practice continue to build NHS Pension Scheme benefits for their NHS work. Check current scheme rules on the official NHS Pensions site.
Who covers me if a private patient makes a claim?
You do — through your own professional indemnity (for example MDU, MPS or MDDUS). NHS state indemnity schemes cover NHS work only. Premiums depend heavily on your specialty and the procedures you undertake, so factor this into any private-practice plan.
Sources
Every figure above is a headline from a primary source and may be revised — always confirm the current position on the official page before you act on it.
Related comparisons
This is free general information, not legal, immigration, financial or medical advice. GeraClinic is a telemedicine platform operated by Gera Services Ltd — it is not a recruitment agency, does not place clinicians into jobs, and does not market specific UK vacancies. Individuals apply to the regulators, employers and UK Visas and Immigration directly and of their own accord. Gera does not actively recruit from any country on the WHO 2023 Health Workforce Support and Safeguards List.