Established practice
You're busy, but you don't know which activity is actually making you money
Being fully booked doesn't mean you're profitable. Some procedures and appointment types generate five times more margin than others. Without the data, you can't optimise what you're doing.
- steps
- 7
- steps
- to start
- 1 hour
- to start
The short answer
Revenue per patient tells you little. What matters is what you keep per hour of your time once hospital, anaesthetist, secretary and insurer shortfalls are taken out. Three months of invoices and your diary are enough to work it out in an afternoon.
7 steps
Do it yourself: step by step
0 of 7 done
Export every invoice from your billing system or practice management software for the last full quarter, with date, patient type (self-pay or insurer), code and amount paid
- Time
- 1 hour
- Typical cost
- Free
- Who does it
- Your secretary
Done when: You have one spreadsheet with every billed episode
This problem is Solvable.
Copy this table
Net income per hour calculator table
Free to copy, adapt and use. No sign-up.
Net income per hour by activity
Period: [Start date] to [End date] Consultant: [Your name]
| Activity | Episodes in period | Gross income | Direct costs | Net income | Total hours (incl. admin, travel, follow-up) | Net £ per hour | Rank |
|---|---|---|---|---|---|---|---|
| New outpatient (self-pay) | |||||||
| New outpatient (insured) | |||||||
| Follow-up | |||||||
| Procedure A: [name] | |||||||
| Procedure B: [name] | |||||||
| Procedure C: [name] | |||||||
| Medicolegal reports | |||||||
| Remote consultations | |||||||
| Total |
Direct costs to include
- Room or clinic hire per session
- Secretary or billing supplier cost per episode
- Consumables or equipment you pay for
- Shortfalls written off or chased unsuccessfully
- Travel time and mileage
Not to include here
- Indemnity, GMC fee, accountancy (these are overheads, spread across everything)
Decision
Top two activities: [ ] Bottom activity: [ ] One change I will make by [date]: [ ]
Avoid these
Common mistakes
- Ranking by fee per case instead of net income per hour of your time.
- Leaving out the admin, letters and post-op calls that follow every procedure.
- Forgetting insurer shortfalls you never collect, which make some work look better than it is.
- Dropping low-margin follow-ups that keep patients and referrers loyal without thinking about the knock-on effect.
- Doing the analysis once and never repeating it after fees or insurer rates change.
Free personal check
Done by Paul Robinson, not software
I'll sense-check what you keep per hour for each type of work and show you where the time goes
What I need from you
- Your calculator inputs
- A rough split of your week by activity
- Your main costs per session, such as rooms and secretary
What you get
- Which activity earns least per hour
- How your pattern compares with typical consultant practices
- One diary change to test
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
Benchmarks
Net income per hour can differ two to three times between a consultant's best and worst activity
Solvable estimate, illustrative: for example about £400 net per hour on a main procedure against £130 to £200 on an insured follow-up once letters and admin are counted. Not a published survey
Solvable estimate
Paul Robinson
14 years in UK private healthcare
I solve this one for consultants
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
Do I need an accountant to do this?
No. A spreadsheet and your billing export are enough. An accountant can check the cost allocation if you want a second view.
How do I count procedure time fairly?
Include pre-op review, theatre, ward rounds, discharge, letters and the first follow-up. That is the time the procedure really takes from you.
What if my best activity is limited by theatre slots?
Then the decision is about which list to ask the hospital for, or which lower-value sessions to give up to free a list.
Should I stop low-margin work?
Not automatically. Some of it feeds your procedures. Check where your procedure patients came from before dropping anything.
How often should I repeat it?
Every six months, and whenever an insurer changes its fee schedule.
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