Established practice

Three people gone in a year, and the shortlist is still empty

Smaller private clinics compete against the NHS and larger groups for the same limited pool of candidates, without comparable benefits or HR support. Vacancies drag on for months, and the cost lands on the people left behind.

steps: 8; steps
to start: Half a day; to start

The short answer

Small clinics cannot outbid the NHS on pension or large groups on salary, so compete on what you can control: flexible and sessional contracts, a proper first 90 days, visible development and a manager who listens. Find out why people actually leave, keep the ones you have, work out the clinical hours your growth plans need, and recruit from a ready plan rather than in a panic.

8 steps

Do it yourself: step by step

0 of 8 done

Count leavers in the last 12 months by role and reason, with headcount, contracted hours, vacancies and agency spend. Hold an exit conversation with every leaver from now on.
Time
Half a day
Typical cost
Free
Who does it
Practice manager
Done when: A one-page workforce summary shows your turnover rate and the top three reasons people leave
Decide where you can compete: sessional, part-time or flexible contracts (including NHS staff who want a few extra sessions), a CPD budget and protected learning time, clinical supervision, and a route to more responsibility such as lead receptionist, senior nurse or clinical lead.
Time
1 day
Typical cost
CPD typically £300 to £1,000 a person a year (Solvable estimate: one or two short courses or a conference place)
Who does it
Clinic owner
Done when: A written offer for each role, and each person has a development goal for the year
Write job descriptions now and keep a list of people who have shown interest. Recruit through more than one route: job boards, professional networks, local NHS contacts, your own clinicians' networks, and a recruitment supplier for hard-to-fill roles. Know which agency or remote support supplier you would use for cover.
Time
2 hours to set up, then 4 to 12 weeks per role
Typical cost
Free to set up; agency fees are often a percentage of first-year salary
Who does it
Practice manager
Done when: You could advertise any role within a day

This problem is Solvable.

Copy this template

Workforce plan, stay conversation guide and 90-day onboarding template

Free to copy, adapt and use. No sign-up.

Template

12-month workforce plan

Clinic: [name] Prepared by: [name] Date: [date]

1. Hours needed

Role	Current weekly hours	Hours needed by [month]	Gap	Driven by
[Nurse]	[ ]	[ ]	[ ]	[New service or extra sessions]
[Physiotherapist]	[ ]	[ ]	[ ]	[ ]
[Healthcare assistant]	[ ]	[ ]	[ ]	[ ]
[Receptionist or administrator]	[ ]	[ ]	[ ]	[ ]

2. Current position

Role	Headcount	Vacancies	Leavers last 12 months	Main reason for leaving	Agency spend last 12 months
[ ]	[ ]	[ ]	[ ]	[ ]	£[ ]

3. Offer comparison

Role	Our pay	Local NHS band	Competitor A	Competitor B	Pension	CPD	Flexibility
[ ]	£[ ]	[Band]	£[ ]	£[ ]	[ ]	[ ]	[ ]

4. Our offer

Contract options: [full-time, part-time, sessional]
CPD: £[amount] and [days] protected days a year
Supervision: [frequency and by whom]
Career route: [for example senior nurse to clinical lead]
Other: [parking, rota notice, no weekend work]

5. Recruitment plan

Role	Route	Start advertising	Target start date	Owner
[ ]	[ ]	[ ]	[ ]	[ ]

---

Stay conversation guide

Name: [ ] Role: [ ] Date: [ ] Held by: [ ]

What do you look forward to when you come to work?
What frustrates you most about the job?
If you were thinking of leaving, what would the reason be?
What is one thing that would make your job easier next month?
What would you like to learn or take on in the next year?
How do you like to be recognised for good work?

Agreed actions: [ ] Follow-up date: [ ]

---

90-day onboarding plan

New starter: [name] Role: [role] Start date: [date] Buddy: [name] Manager: [name]

Before day one

Contract, DBS and registration checks complete
Logins for practice system, email and phones set up
Rota for first four weeks sent

Week one

Welcome and tour, introductions to every team member
Policies: safeguarding, information governance, infection control, fire, complaints
Shadow [buddy] for [number] sessions
End-of-week check-in with manager

Weeks two to four

Competency sign-off list for the role: [list tasks]
Mandatory training completed: [list modules]
Week four check-in: what is going well, what is not

Weeks five to twelve

Working independently on [tasks]
One development goal agreed
Week twelve review and probation decision

Signed: [new starter] [manager] [date]

Avoid these

Common mistakes

Recruiting in a panic after someone resigns, with no job description ready.
Announcing a new service before the staff to run it are recruited.
Leaving new starters to learn by watching, with no written plan.
Assuming pay is the reason people leave without asking them.
Ignoring NHS staff who want a few extra sessions a week.
Letting agency cover become permanent because nobody tracks the cost.
Promoting the best clinician into management with no support.

Free personal check

Done by Paul Robinson, not software

Answer seven quick questions and I'll show you where you're losing staff and what to change first

What I need from you

Seven tap answers about recruitment and retention
Roughly how many staff you have

What you get

Where your offer falls short of what good small employers do
The three changes that matter most
Which ones cost little or nothing

Within 2 working days

No sign-in, no sales call. I read every request myself and reply on WhatsApp.

Free tools

Check where you stand

Your illustrative estimate

£20,500

Solvable estimate. Rounded to the nearest £500. Updates as you type.

Headcount

Starting figure 15. Change it to match your practice.

Turnover rate

Starting figure 25%. Change it to match your practice.

Cost per replacement

Starting figure £16,500 (midpoint of £8,000 for admin roles to £25,000 for clinical roles (Solvable estimate, scaled down from the Oxford Economics 2014 average of £30,614 for smaller clinic roles)). Change it to match your practice.

Share preventable

Starting figure 33.3333333333% (from one third (Solvable estimate: some leavers go for reasons no clinic can change, such as moving or retiring)). Change it to match your practice.

Formula

Annual cost of turnover = headcount × turnover rate × cost per replacement; recoverable = annual cost of turnover × share of leavers a retention plan can prevent

Variables and defaults

headcount: 15
turnover rate: 25%
cost per replacement: £8,000 for admin roles to £25,000 for clinical roles (Solvable estimate, scaled down from the Oxford Economics 2014 average of £30,614 for smaller clinic roles)
share preventable: one third (Solvable estimate: some leavers go for reasons no clinic can change, such as moving or retiring)

Defaults only. Change them in the calculator to use your own numbers.

Assumptions and defaults

headcount = 15
turnover rate = 25%
cost per replacement = £8,000 for admin roles to £25,000 for clinical roles (Solvable estimate, scaled down from the Oxford Economics 2014 average of £30,614 for smaller clinic roles)
share preventable = one third (Solvable estimate: some leavers go for reasons no clinic can change, such as moving or retiring)

About 3.75 leavers a year. The total cost of turnover is about £30,000 a year if every leaver is in an admin role, up to about £94,000 if every leaver is clinical (context). A retention plan that prevents about a third of leavers recovers roughly £10,000 to £31,000 a year, or about £20,500 for an even mix of admin and clinical roles. Solvable estimate. Growth you cannot deliver because sessions are unstaffed comes on top of this.

Benchmarks

£30,614
Average cost of replacing an employee earning £25,000 or more, including lost output while a replacement gets up to speed (2014 figures, so treat as a dated guide)
Source: Oxford Economics, The Cost of Brain Drain (2014), as reported by HR Review
£12.71 an hour
National Living Wage from 1 April 2026 for workers aged 21 and over, the floor for reception, healthcare assistant and support pay
Source: GOV.UK press release
3 to 6 months
Typical time to recruit and fully onboard a specialist clinical role in a small private clinic
Solvable estimate

Every supplier I know who solves this. No one pays to be listed. Where I've worked with them, I say so.

Lila's Desk
Reception and secretarial
Remote medical secretaries and admin assistants for small clinics and private practices, booked by the hour.
Remote secretaries and front-desk cover to fill gaps or take admin off stretched staff.
Best for: Small clinics and private practices
Price on request
No commercial relationship

Know a supplier I have missed? Tell me Suggest yourself

Smaller private clinics compete with the NHS and larger private groups for a limited pool of staff, often unable to offer comparable benefits or dedicated HR resources. High turnover is both a cost and a quality risk.

Structural root causes include intense competition for a limited pool of skilled healthcare professionals from both the NHS and larger private groups, often exacerbated by regional shortages.
Behavioural causes stem from inadequate employee engagement strategies, lack of career development opportunities, and poor work-life balance.
Systemic issues involve insufficient investment in workforce planning and training pipelines for private healthcare, leading to a perpetual supply-demand imbalance.

A private clinic with 10 staff and 30% annual turnover could incur approximately £91,842 in replacement costs per year (Oxford Economics, 2014)

Increased reliance on locum or agency staff, leading to higher operational costs and administrative burden
Reduced efficiency and productivity due to constant onboarding and training of new hires
Significant expenditure on recruitment fees, advertising, and temporary staffing (e.g., £91,842 annually for a clinic with 10 staff and 30% turnover)
Loss of revenue from reduced patient capacity or delayed appointments
Compromised patient safety and quality of care due to lack of continuity and experienced staff
Delays in diagnosis and treatment, potentially leading to poorer patient outcomes
Negative patient reviews and word-of-mouth, damaging the clinic's reputation and ability to attract new patients
Difficulty in attracting high-calibre clinical talent due to a perception of instability or poor working conditions

What it looks like in practice

Frequent agency staff usage to cover shifts, leading to higher costs and inconsistent care
Delays in patient appointments or reduced service capacity due to staff shortages
Increased complaints from patients regarding staff changes or lack of familiarity
Overworked permanent staff exhibiting signs of burnout, leading to further resignations

Paul Robinson

14 years in UK private healthcare

I solve this one for clinic and hospital teams

Want a hand? I'll look at your situation and tell you the three things I'd tackle first.

A few quick questions, about two minutes. I read every one myself and usually reply the same day.

No sales call unless you ask for one. Just a straight answer from me.

I reply personally, usually the same day.

Questions

Frequently asked questions

We cannot match NHS pensions. What can we offer?

Flexibility, predictable rotas, less bureaucracy, a CPD budget, supervision and a manager who knows the team. These matter to many people more than pension.

Can we offer the NHS Pension?

Usually not. An independent clinic can apply to NHS Business Services Authority for access only if it delivers NHS-funded services under an NHS contract. A purely private clinic cannot offer it. Staff who also work for the NHS keep NHS Pension through their NHS role. This is general information; check with NHS Pensions or a pensions adviser.

What is a normal turnover rate?

It varies by role and region. Track your own and aim to bring it down year on year.

Are stay conversations worth the time?

Yes. They are cheaper than an exit interview because they happen before the person leaves.

Should we use sessional contracts?

They suit clinicians who want flexibility or extra work alongside an NHS job, and they let you grow session by session.

Should we use agency staff?

For short-term cover, yes. For permanent growth it usually costs too much and weakens continuity, so track the cost monthly.

How far ahead should we recruit for a new service?

Three to six months before launch for specialist clinical roles (Solvable estimate).

Can remote admin support help?

Yes, for letters, phones and bookings, which lets in-clinic staff focus on patients.

Last reviewed: 30 October 2026

Sources

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The short answer

Do it yourself: step by step

1Measure turnover and why people leaveHalf a day · Free

2Ask the people who stayed20 mins per person · Free

3Turn growth plans into hoursHalf a day · Free

4Benchmark pay and benefits1 day · Free

5Design an offer you can afford1 day · CPD typically £300 to £1,000 a person a year (Solvable estimate: one or two short courses or a conference place)

6Build a 90-day onboarding plan1 day to write · Free

7Keep a warm recruitment plan2 hours to set up, then 4 to 12 weeks per role · Free to set up; agency fees are often a percentage of first-year salary

8Review quarterly1 hour a quarter · Free