How to start up a physiotherapy practice

If you're a trained and qualified physiotherapist you might decide to set up your own practice. You'll find all you need to start up and run your own physiotherapy practice in our practical guide.

Research your target market

Estimating demand

You'll need to estimate whether there is enough local demand for your private physiotherapy practice. It's likely that a large number of your patients will be referred to you by medical practices, so you may find it useful to talk to GPs in your area as they may be able to give you an idea of how many patients they currently refer to private physiotherapists. 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, though you may consider talking to other, established private practitioners. (You may find that they are reluctant to share patient details with a potential competitor but it can't hurt to ask!)

If you are intending to specialise in treating a certain type of patient - sports injuries for example - bear in mind that by specialising, you are reducing your potential client base. However, you may find that targeting new clients is easier if you are a specialist rather than a generalist, especially if you can offer advanced skills or techniques. If you are moving into private practice straight from the NHS it is possible that you already have a core of patients that you have been treating privately in your spare time that you are confident will remain loyal once you set up on your own.

Competition

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

Why will patients choose you

Patients tend to fall into the following categories:

It's a good idea to build relationships with those health professionals and organisations who will potentially refer patients to you or who can give patients information about your practice so they can self-refer. These will include:

Many of your patients will be referred by a GP, so it is important that you build relationships with as many practices in your area as possible. You could contact them in person and give them a brochure detailing exactly what you can offer and what prices you charge. If you are a member of Physio First - which started out as the the Organisation of Chartered Physiotherapists in Private Practice (OCPPP) - then your name will automatically appear in their directory and on their website, both of which are extensively used by referring health professionals to locate physiotherapy services.

Patients that self-refer to you may do so for a number of reasons, such as:

The Chartered Society of Physiotherapists (CSP) produces a booklet on marketing a private practice. Contact the CSP for further details.

Research current trends, plus legal and tax issues

Establish your patient profile

The profile of your patients, their ages and their treatment needs will largely depend on the focus of your practice. If you specialise in a certain area, such as sports injuries, then the majority of your patients will be sports people (recreational, amateur and professional) and people who wouldn't necessarily class themselves as sports people but who have injured themselves during a recreational activity (for example, skiing) whereas if you run a general physiotherapy practice you are likely to see patients from a broad age spectrum with diverse treatment needs.

Generally, your patients will fall into these categories:

Patients that are covered by health insurance traditionally have paid the physiotherapist for treatment and then recovered the cost of the treatment from their insurance company themselves. However it is becoming increasingly common for the patient to give the physiotherapist the claim forms and for the physiotherapist to claim from the insurance company. Bear in mind that some insurance companies limit the number of sessions that they will fund in a course of treatment.

NHS patients are funded by the local Clinical Commissioning Group (CCG) or Health Board.

Discounts and special offers

You may find that you will have to offer discounts on your normal fees to secure work from health insurance companies, and some commercial intermediaries may also try to negotiate your fees downwards. Contracts for NHS work may be set at a nationally or locally agreed rate that is some way below the amount you normally charge.

You may also offer discounts to patients who you see on a regular basis.

Qualifying as a physiotherapist

Generally, to qualify as a state registered physiotherapist you have to take a three or four year full-time degree course. If you are a school-leaver in England, Wales and Northern Ireland, the required qualifications normally needed to apply for a degree course in physiotherapy are:

For students in Scotland, five SCE Highers at grades AABBB is usual and for students in the Republic of Ireland an Irish Leaving Certificate with four passes at the higher level with two at grade B and two at grade C is usual.

Alternative qualifications to A levels may be acceptable. Contact the universities that offer degree courses in physiotherapy to find out their specific entry requirements. These are listed on the Chartered Society of Physiotherapists (CSP) website.

It is highly recommended that, before setting up in private practice, a physiotherapist should obtain the necessary qualifications and then work within the NHS for a minimum of two years - preferably five. This period will ensure that a physiotherapist receives sufficient experience of different disciplines, such as out-patients, intensive care, neurology and so on.

More information on how to qualify as a physiotherapist is available from the CSP website.

Standards of practice

There are a number of important standards documents that you need to be aware of that cover your professional conduct and your practice procedures.

All physiotherapists are regulated by the Health and Care Professions Council (HCPC) and must meet the HCPC's professional standards. These are set out in 'Standards of proficiency - Physiotherapists' and 'Standards of conduct, performance and ethics', both of which you can download from the HCPC website. Physiotherapists must also observe certain standards for continuing professional development.

Members of the Chartered Society of Physiotherapists (CSP) must comply with the CSP's 'Code of Professional Values and Behaviour' and should also aim to meet the 'Quality Assurance Standards' which replaced the previous 'Core Standards of Physiotherapy Practice' and 'Service Standards of Physiotherapy Practice'.

The member-only CSP document 'Thinking of Private Practice' includes a helpful section on professional conduct and responsibilities.

Decide what services to offer

The services you offer will depend on the type of practice 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. For example, equipping your practice with equipment such as electrotherapy machines or a hydro pool may not initially be viable.

You may decide to offer general physiotherapy services or alternatively focus on one or more area of specialism, such as:

If you decide to specialise in a certain area it's important that you try to exploit as many of the available sources of patients as possible. For example, if you specialise in sports injuries, you could offer your services to a local sports team and attend their matches in a professional capacity. Alternatively you could offer a call-out service to a local sports club or leisure centre.

You may find it profitable for your practice to offer alternative therapies, such as osteopathy, chiropractic and so on. You could offer these yourself if you have the necessary skills - and time - or work in conjunction with other practitioners trained in those areas.

The right image

It is important for the financial well-being of your practice as well as the safety of your patients that the practice is run in a professional manner. Patients will be put off by shabby premises and there may be health and safety implications if equipment is poorly maintained. The Chartered Society of Physiotherapists (CSP) produces guidelines on good practice in their Quality Assurance Standards document. Physio First - which started out as the Organisation of Chartered Physiotherapists in Private Practice (OCPPP) - also produces guidelines for good practice.

Pricing policy

Getting your fees right is an important part of making sure the practice gets off to a good start. You may already have a core of patients that you have been seeing privately outside of working hours when you were employed by the NHS and will have an idea of how much to charge. However, you may find that you will have to increase that rate to cover practice overheads and for you to make a profit.

To establish the going rate for treatment in your area you could call established practices or look at their websites. This should give you a good idea of the fee levels that the local market is able to bear and may also highlight any opportunities for you to charge a bit more than the going rate, for example if you're particularly well qualified in a certain area. If you are approved as a healthcare professional by an insurance company, for example as part of the BUPA Physiotherapy Network, you will find that the insurers will put pressure on the fees you charge. This is particularly the case during recessions or if your fees are higher than other physiotherapists in your area. If you don't agree to their terms you are likely to find that you will not have your contract renewed and will cease to get referrals from them.

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 prefer to pass the claim forms to you after treatment has been completed and then you will have to collect your fees from the insurance company. If you take NHS patients, your fees for these will be paid by the local Clinical Commissioning Group (CCG) or Health Board in whose area the referring GP practises.

It will ease your cash flow if you can charge your patients at the completion of each session, rather than at the end of a course of treatments, particularly with long treatments, such as for the pelvic floor, which can take up to a year to complete. Bear in mind though that some insurance companies will not allow you to claim staged payments in this way. To avoid misunderstandings, it's a good idea to make your payment terms clear to patients before treatment begins.

Discounts

You may come under pressure to lower your fee rates when dealing with health insurance companies and commercial intermediaries and you may also find that the pre-set rates for NHS work are somewhat lower than your normal fees.

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

Promote your business

It is likely that you will choose to advertise your practice to attract as many patients as possible. If you join Physio First your name will be published in their directory which is widely used by health professionals when they need to refer a patient. You will also be able to use the Physio First logo and be able to sign up to the Physio First online appointment booking facility.

Members of the Chartered Society of Physiotherapists (CSP) can advertise their practices free of charge in the CSP's 'Physio2U' online directory, and also have the option to pay for an enhanced listing. If you are a member of the CSP then you will be familiar with the 'Quality Assurance Standards', section 10 of which provides guidelines on promoting, marketing and advertising physiotherapy services and products.

CSP members can also access marketing advice on the CSP website and from the guidance document 'Thinking of Private Practice'.

Other ideas for advertising your practice include:

If you plan to treat patients funded by the NHS, you also need to be aware of the rules covering the promotion of NHS funded services.

Buy an existing business

You might decide to buy an existing physiotherapy practice rather than start your own venture from scratch. Buying a going concern can mean that the patients, staff, premises and equipment are already in place.

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:

  • if the reputation and success of the practice depend to a large extent on specific skills of the seller (Alexander technique, for example) do you have comparable abilities

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