Specialist Accountants for Private Consultants, Clinics & Medico-Legal Practices
Private practice is a business, and most consultants start one without ever intending to. Insurer remittances arrive net of unexplained deductions, self-pay patients take months to settle, secretarial and room hire costs mount up, and the extra income quietly drags your Annual Allowance into tapering. Our accountants for private medical practitioners put a proper structure around all of it, so your private work adds to your income rather than to your admin.
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We act for clinicians running private work alongside an NHS commitment as well as those in full-time independent practice, across London and the wider UK.
Private fees alongside your NHS contract, tapering and Annual Allowance control, incorporation reviews and clean separation of the two income streams.
Complete accounts, VAT reviews, payroll for secretaries and clinical staff, premises and equipment finance, and profit extraction planning.
Company or partnership accounts, multi-practitioner profit sharing, CQC-ready record keeping, staff payroll and management information by clinic or service line.
Report income and expert fees, VAT registration where the medical exemption does not apply, disbursement handling and long debtor cycles managed properly.
Every service below is built around how private medicine actually earns — insurer schedules, self-pay invoices, hospital remittances and medico-legal fees — not around a generic small business template.
Annual accounts with income analysed by insurer, hospital, clinic and self-pay, so you can see which parts of your practice genuinely pay and which merely keep you busy.
Sole trader, partnership or limited company modelled on your real figures, including the NHS pension consequences and the effect on your Annual Allowance.
Where medical exemption ends, whether cosmetic, medico-legal, training or consultancy income takes you over the threshold, and partial exemption where both apply.
Cloud bookkeeping linked to your billing, insurer remittance reconciliation and structured chasing of aged self-pay debt that would otherwise never be collected.
RTI payroll for medical secretaries, nurses and administrators, auto-enrolment pensions, and advice on employment versus self-employment for sessional staff.
Private practice generates financial problems that no NHS role prepares you for. These are the ones we fix:
Insurer remittances short-paid with no explanation
Self-pay invoices unpaid for months and never chased
Private income pushing you into Annual Allowance tapering
Uncertainty over VAT on cosmetic and medico-legal work
Secretarial and room hire costs eroding thin margins
Private work run through the wrong legal structure
No management information until the year has ended
Private medicine needs an accountant who understands both clinical income and ordinary business economics. Here is what you get:
Reporting by insurer, hospital site and service line, so you can see the true margin on each part of your practice.
Tapering and Annual Allowance modelled with your private income included, before the year ends rather than after the statement arrives.
Clear guidance on where the medical exemption stops, with registration, scheme choice and partial exemption managed for you.
Structured credit control on insurer and self-pay balances, which for most new clients recovers more than our fee in the first year.
A written comparison of sole trader, partnership and company, including the pension effect that most general accountants overlook.
One agreed monthly fee, quoted up front, with unlimited telephone and email support included.
Private practice should generate income, not paperwork. Our three-step process gets you set up quickly and keeps you informed all year:
We begin by getting to know your practice and understanding your unique needs. This step ensures we have a clear picture of your operations and your goals.
Based on our initial discussion, we create a personalised plan designed specifically for you. The aim is to keep everything organised and easy to follow. You can rest assured that your numbers are being handled with expert precision.
From there, we take care of the ongoing work and keep you updated with reports. You’ll always know what’s happening, and we’re always here to answer your questions, ensuring you have a clear picture of your financial health at all times.
Chartered, experienced and genuinely specialised in healthcare. Here is what working with us looks like in practice:
We use Xero, Quickbooks, Sage & many other online software.
Meet, call or email the same qualified accountant who knows your practice and your pension position.
Free telephone & email support
throughout the year.
Our team have over 100 years of combined experienced.
Never Miss any deadline with our automated email reminders.
We’re an ICAEW, ACCA & AAT accredited Firm.
Take a back seat and let our specialist healthcare accountants handle everything. Switching part way through the year is straightforward and you never need to speak to your old accountant:
Reach out to us, and we’ll discuss your needs and how we can help your healthcare practice thrive.
We’ll send over a simple letter to formalise our partnership and get everything in motion.
If you're switching, we’ll take care of contacting your previous accountants to make the transition smooth.
From there, sit back and relax. We’ll manage your accounts, taxes, and everything in between, keeping your practice running smoothly.
Before you see your first private patient if possible. The decisions made at the start, on structure, billing, record keeping and VAT, are far cheaper to get right than to unpick two years later. If you are already trading, the next best time is now.
Sole trader is simplest and keeps administration low. A partnership suits genuine group practices. A company can be efficient where you retain profits or employ staff, but the income is not NHS pensionable and it adds filing obligations. We model all three on your actual figures.
Medical care provided by a registered practitioner for the protection, maintenance or restoration of health is exempt. Purely cosmetic procedures, medico-legal reports, expert witness work, training and consultancy are generally standard rated and count towards the registration threshold. Many practitioners have a mix and need partial exemption calculations.
Medical indemnity, GMC and college subscriptions, secretarial and billing costs, room and theatre hire, clinical equipment and consumables, professional insurance, courses and conferences, business travel, accountancy fees and a proportion of home and phone costs where genuinely used for the practice.
Private income increases your adjusted income, which is what determines whether the tapered Annual Allowance applies to your NHS pension growth. A good private year can therefore create a pension tax charge even though the private income itself is not pensionable. We test this every year.
Both work. An employed secretary gives you control and continuity but brings payroll, pension and employment obligations. A billing company converts a fixed cost into a percentage of collections and often improves recovery rates. We compare the true cost of each against your billing volume.
Shortfalls are usually caused by benefit maxima, coding mismatches or fee schedule differences rather than error. The important thing is that every remittance is reconciled to the invoice so shortfalls are identified and either recharged to the patient where permitted or challenged with the insurer.
Yes. Capital allowances are available on clinical equipment, IT and integral features in premises you own or lease, and the annual investment allowance often gives full relief in the year of purchase. Finance and leasing arrangements are treated differently, so the structure of the purchase matters.
Most higher and additional rate practitioners should reserve at least 45 per cent of net private profit, plus an allowance for payments on account in the first year and for any Annual Allowance charge. We give you a personalised figure and update it as the year progresses.
Yes. For clinics and group practices we produce monthly or quarterly management accounts with analysis by clinician, site and service, plus cash-flow forecasting, so decisions on staffing and pricing are made on current data.
We quote one fixed monthly or annual fee based on the size of the practice and whether bookkeeping, payroll and VAT are included. The quote is agreed before any work starts and includes unlimited support.
Yes. We are based in Morden, South London, close to the main private hospitals, and act for practitioners across the UK using secure cloud accounting and video meetings.
Please double-check the figures before you act. The tax, NHS pension and accounting information on this page is general guidance for UK doctors and healthcare professionals, not personal advice. Tax rates, allowances, thresholds and NHS pension rules change regularly, including at each Budget and at the start of every tax year on 6 April. VAT registration thresholds, the medical exemption rules and income tax bands are all subject to change. Always cross-check any rates or figures against HMRC, the NHS Business Services Authority and the latest Budget announcements, or speak to one of our qualified accountants before acting. CruseBurke cannot accept liability for decisions made solely on the basis of this page. Last reviewed: August 2026.
