How to start up a chiropractic clinic

Chiropractors mostly provide treatment for neck and back pain although they also treat patients who consult them on a range of other conditions. Check out our practical guide for starting and running your own chiropractic clinic.

Research your target market

Estimating demand

You will have to try to estimate if there is enough local demand for your chiropractic clinic. As it is likely that some of your patients will be referred to you by GPs and other health professionals, you may find it useful to talk to those in your area as they may be able to give you an idea of the number of patients they currently refer for chiropractic treatment. (Although at the moment most patients don't get their treatment paid for by the NHS, many GPs are aware of the benefits of chiropractic and will refer patients, even though the patient will have to pay for the treatment themselves or through their private medical insurance.)

The other main source of patients is those that self-refer - that is they do not go through a GP or other health professional. It may be difficult to assess the level of demand from this type of patient unless you have prior experience of working in a local practice but you could consider discussing this with established chiropractors in your area. (You may find that they are reluctant to share patient details with a potential competitor but it can't hurt to ask!)

Competition

Try to assess the level of competition in your area. Your competitors will include:

  • other chiropractic clinics
  • other private practitioners and complementary therapists that treat a similar range of conditions, such as physiotherapists, osteopaths and masseurs
  • private hospitals
  • GPs with in-house physiotherapists or osteopaths

If you intend to specialise - in animal chiropractic - for example, you are likely to find that the number of direct competitors will be reduced.

You can use the Find a Chiropractor tool on the British Chiropractic Association (BCA) website to see how many chiropractors are practising in your area.

Why will patients choose you

Patients tend to fall into the following categories:

  • those that self-refer. These patients may be covered by insurance (some companies do not require a GP referral) or may be paying out of their own pockets
  • those that are covered by health insurance companies. The majority of these patients will be referred to you by a GP
  • those that are referred by a GP after requesting chiropractic treatment and who will pay for the treatment themselves
  • those that are referred to you by a GP and are paid for by the NHS

You need to make sure that enough clients choose your practice so it's important to build relationships with those health professionals and organisations who will refer patients to you or can give patients information about your clinic so they can self-refer. These will include:

  • local GPs
  • consultants and rehabilitation departments in local hospitals (both NHS and private)
  • large corporations. These are becoming increasingly aware that musculo-skeletal problems are very common and cost a great deal to industry in terms of days lost. Businesses in your area may decide to offer their employees free chiropractic treatment to try to minimise the days lost through these types of complaints
  • nursing homes
  • retirement homes
  • sports clubs
  • leisure centres

As many of your patients will be referred by a GP, it is important that you build relationships with the GPs in your area. You could contact them in person and give them a brochure detailing exactly what you can offer and what prices you charge.

Research current trends, plus legal and tax issues

Patient profile

Your market

Chiropractic treatment is effective for people of all ages, from babies to the very elderly and unless you intend to specialise in treating a certain age group, you are likely to have patients from a broad age spectrum with a variety of complaints, including:

  • back pain, such as scoliosis; hip, groin and pelvic pain; sciatica and muscle and ligament injuries
  • neck pain
  • shoulder injuries
  • whiplash injuries
  • sports injuries

Generally, your patients will fall into these categories:

  • those that have been referred to you by a GP (or another health professional) and are either covered by health insurance, will pay out of their own pockets or have the cost of their treatment covered by their employer
  • those that are referred to you by a GP but paid for by the NHS. Although NHS-funded chiropractic treatment is sometimes an option, it is not currently widespread
  • those that have self-referred. These patients may be covered by insurance (some companies do not require a GP referral) or may be paying out of their own pockets

For patients that are referred to you by a GP as NHS patients you will be paid by the Clinical Commissioning Group (CCG) or Health Board that the GP belongs to, rather than by the GP.

Animals

Chiropractic treatment can be very effective for animals that are suffering from musculo-skeletal problems and if you are qualified to treat them, you may treat all sorts of animals, such as horses, dogs, cats and farm animals. According to the McTimoney Chiropractic Association, in practice this is likely to mean working closely with an animal's veterinary team.

Decide which services to offer

The services you offer will depend on the type of clinic you intend to run. The size of your premises and the amount of money you have available for starting up may dictate the extent of the services you are initially able to offer.

Chiropractic will be the core service that your clinic offers. Depending on your training, you may offer conventional chiropractic or a variant, such as McTimoney or McTimoney-Corley. Although chiropractors are best known for providing back treatment and care, chiropractic can also be an effective treatment for a number of other complaints.

As well as treating your patients' complaints, you are also likely to provide information and advice which will help recovery and prevent further problems in the future. This may include specific exercise and self help programs, lifestyle advice and general guidance to improve posture and help reduce pain. You might also offer retail sales of goods and equipment that can help patients with their conditions. However, be aware that, according to the General Chiropractic Council (GCC) rules, any retail sale of equipment to a patient must be on the basis of clinical judgement and not commercial gain. Chiropractic is also used on animals, as these can suffer from the same musculo-skeletal problems as humans.

Aside from chiropractic, if you or your staff have the required skills you may decide to offer various other services and treatments that would broaden the appeal of your clinic. These may include:

  • massage
  • craniosacral therapy
  • acupuncture
  • physiotherapy
  • aromatherapy

Opening hours

It's a good idea to be flexible when deciding on the opening hours for your clinic. Bear in mind that it will be difficult or impossible for some of your patients to attend your clinic in normal working hours. You may decide to open on weekends or late in the evenings for a couple of days a week to accommodate these patients. You may also decide to offer home visits.

The right image

It is important for the financial well-being of your clinic as well as the safety of your patients that the clinic is run in a professional manner. Patients may be put off by shabby premises and there may be health and safety implications if equipment is poorly maintained. You should also prominently display your qualifications so that patients are reassured of your professional competence. Some patients won't know what to expect and may be a little nervous on their first appointment, so try to put them at ease by discussing their treatment with them, encouraging them to ask questions and addressing any concerns they might have.

Pricing policy

Setting your fees at the right level is an important part of making sure the clinic gets off to a good start. If you have previously worked in a clinic in the area where your business will be located, you will already have a good idea of the level of fees that patients are prepared to pay.

If you are not sure of how much to charge, you could contact established clinics in your area or look online for chiropractic clinics' websites. You may decide to charge less than the going rate to try to attract more patients. Alternatively, you may feel that you can charge more than the going rate, for example if you are very experienced or highly qualified.

Payment

The majority of your patients will pay you out of their own pockets - some will then claim the fees back from their insurance company. Some patients covered by insurance companies will pass the claim forms to you after treatment has been completed and you will have to collect your fees from the insurance company. If you have any NHS patients, your fees for these will be paid by the Clinical Commissioning Group (CCG) or Health Board in whose area the referring GP practices.

It will ease your cash flow if you can charge your patients at the completion of each treatment, rather than at the end of a course of treatments, particularly with long treatments. Make your payment terms clear to the patient before treatment begins so that there is no confusion over how much their treatment will cost and when they have to pay you.

Discounts

You are likely to find that you will have to offer discounts on your normal fees to secure work from health insurance companies and you're also likely to find that tariffs for NHS work will be set locally or nationally and may be some way below your normal fee rate.

You may also offer discounts to regular customers or patients who will need a long course of treatment.

Promote your business

You will hope to benefit from word-of-mouth recommendations from patients who pass on your details. There are also various ways in which you can promote your clinic and build up your practice. You could advertise your clinic in the following ways:

  • through a listing on the General Chiropractic Council (GCC) website. All registered chiropractors are automatically listed in the register on the GCC website
  • through a listing on a professional association website, such as the British Chiropractic Association, the McTimoney Chiropractic Association or the Association of McTimoney-Corley Skeletal Therapists
  • taking an advert on Yell.com or in local printed directories. In your advert it's a good idea to give prospective patients a clear idea of the complaints that you can treat. For example, you could list back pain, sore joints, sports injuries, and so on
  • having a brochure printed which details your services and prices. You could then distribute this to local GPs, consultants, rehabilitation departments in NHS and private hospitals, other complementary therapy centres, care homes, local businesses, sports clubs, leisure centres and anywhere else that may generate custom. You may find that putting a few of these in unrelated businesses such as fish and chip shops may also attract patients
  • placing an advert in local newspapers
  • setting up your own website - you may decide to offer an online appointment booking service
  • using social media like Facebook and Twitter to improve patient retention and boost referrals

Almost all types of advertising and promotion have a cost, whether it's financial or your own time and effort - or both. You need to make sure that the beneficial effects of your advertising efforts are worth the time and money spent on them. It's up to you to decide which types of advertising work best for you - sometimes this is down to trial and error.

Bear in mind that the claims you make for the effectiveness of your treatments must be based on the best available evidence. You can download Guidance on Advertising and Guidance on the use of Social Media from the GCC website.

Buy an existing business

You might decide to buy an existing farm supply business rather than start your own venture from scratch. Buying a going concern can mean that the products, customers, regular sales, staff, premises and equipment are already in place.

Buying an existing business may mean that:

  • there are existing relationships with local GPs and other health professionals, businesses, hospitals, sports centres and other businesses, which should mean continued patient referrals?

But buying a business can be a hazardous, expensive process unless you have the right skills and experience on your team, including legal and financial know-how. Establish the genuine trading and financial position, so that the price you pay for the business is not too high.

Other matters to consider include:

  • whether the vendor intends to keep on practising in the same area. If this is the case it is quite likely that some - or even all - of the existing client base will migrate with them
  • if the success of the clinic relies on specific skills of the seller (McTimoney, for example) do you have comparable abilities

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