Established practice

Your overheads have crept up and are eating your margin

Private practice overheads tend to accumulate gradually. Software subscriptions, PA costs, premises fees, and insurance premiums each increase slightly year on year, and without a regular review, the cumulative effect erodes margin significantly. Consultants who do not actively manage their cost base often find that revenue growth is entirely absorbed by overhead inflation.

steps: 7; steps
to start: 3 hours; to start

The short answer

Overheads rarely jump. They creep, through auto-renewals, annual price rises and services nobody reviews. Once a year, list every cost with its renewal date, cancel what you do not use and retender the three largest, usually indemnity, room or clinic hire and secretarial or billing support. Do your fee review in the same month so costs and fees move together.

7 steps

Do it yourself: step by step

0 of 7 done

Go through 12 months of bank and card statements and list every recurring cost: supplier, annual cost, renewal date and notice period
Time
3 hours
Typical cost
£0
Who does it
You or your accountant
Done when: Every cost over £100 a year is on one sheet with a renewal date

This problem is Solvable.

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Private practice overhead cost register

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Table

Overhead cost register: [year]

Category	Supplier	Annual cost (£)	Still needed?	Action
Medical indemnity	[ ]		Yes	Retender like-for-like
Room or clinic hire, site 1	[ ]
Room or clinic hire, site 2	[ ]
Secretary (salary, pension, employer's NI)	[ ]
Billing or debt collection	[ ]
Practice management software	[ ]
Dictation or transcription	[ ]
Website and hosting	[ ]
Directory and listing fees	[ ]
Google Ads or other advertising	[ ]
Phone lines and call handling	[ ]
ICO data protection fee	ICO	52 or 78	Yes	Pay on time
GMC annual fee	GMC		Yes
Royal College or specialty association	[ ]
Accountant	[ ]
Professional development and travel	[ ]
Bank and card payment fees	[ ]
Other	[ ]
Total

Summary

Measure	This year	Last year
Total private income	£[ ]	£[ ]
Total overheads	£[ ]	£[ ]
Overheads as % of income	[ ]%	[ ]%
New patients	[ ]	[ ]
Overhead per new patient	£[ ]	£[ ]

Rules

Anything with a renewal date goes in the diary 90 days before.
Indemnity: never switch claims-made cover without run-off or retroactive cover in writing.
Review fees in the same month as this register.

Avoid these

Common mistakes

Letting indemnity auto-renew for years without a like-for-like comparison.
Switching from claims-made indemnity without arranging run-off cover for past work.
Paying for clinic sessions that are regularly half empty.
Keeping software subscriptions for systems nobody has logged into for months.
Raising costs every year while leaving self-pay fees untouched.

Free personal check

Done by Paul Robinson, not software

I'll sense-check your overheads and show where a saving is most likely

What I need from you

Total annual overheads
Your three largest costs and what they cost a year
Private income last year

What you get

Your margin compared with what I usually see
Where a saving is most likely
Renewals to put in the diary

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

£6,000

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

Total annual overheads

Starting figure £60,000 (from £60,000 (Solvable estimate for a solo consultant with a part-time secretary; use your own cost register)). Change it to match your practice.

Recoverable share

Starting figure 10% (midpoint of 5 to 15% (Solvable estimate)). Change it to match your practice.

Formula

Avoidable annual cost = total annual overheads x share recoverable through review.

Variables and defaults

total annual overheads: £60,000 (Solvable estimate for a solo consultant with a part-time secretary; use your own cost register)
recoverable share: 5 to 15% (Solvable estimate)

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

Assumptions and defaults

total annual overheads = £60,000 (Solvable estimate for a solo consultant with a part-time secretary; use your own cost register)
recoverable share = 5 to 15% (Solvable estimate)

£60,000 x 5 to 15% gives roughly £3,000 to £9,000 a year, recurring, from one afternoon's review plus quotes (Solvable estimate).

Benchmarks

The ICO data protection fee is £52 a year for tier 1 (micro) and £78 for tier 2 (small and medium) organisations
Fees rose in February 2025
Source: GOV.UK Pay the data protection fee
A first structured review usually recovers 5 to 15% of overheads
Solvable estimate, not a published figure: mostly from unused subscriptions, room sessions and retendered indemnity
Solvable estimate

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

Medical Billing & Collection
Billing and revenue
Outsourced billing, insurer e-billing and patient payment collection for private consultants, groups and clinics, charged on income collected.
Outsourced billing covering both insurer and self-pay invoices, for consultants and small clinics.
Best for: Consultants wanting fully outsourced billing
Price on request
No commercial relationship
Quest Medical Indemnity
Indemnity and insurance
Independent broker arranging medical malpractice and regulatory legal expenses cover for private consultants, clinics and group practices.
Independent broker, so it can compare medical malpractice cover across insurers rather than sell one product.
Best for: Private consultants and clinics
Price on request
Former client

Know a supplier I have missed? Tell me Suggest yourself

Costs increase in small increments that individually feel manageable There is no regular overhead review built into practice management Some costs such as indemnity and software are auto-renewed without comparison

Software subscriptions accumulate across multiple vendors
Indemnity premiums are renewed without shopping the market
PA costs increase without a corresponding review of output
No monthly P&L is maintained for the private practice
Cost inflation is not offset by fee increases

Every percentage point of overhead that exceeds revenue growth directly reduces net income. A 10% cost reduction on a £400,000 overhead base saves £40,000 per year.

Margin compresses even as revenue grows
The consultant is working harder for the same or less net income
Cash flow becomes tighter as standing costs rise
The practice becomes less resilient to revenue dips
Investment in growth is crowded out by overhead

What it looks like in practice

A consultant on a £400,000 overhead base with 6% annual cost inflation adds £24,000 of additional annual cost with no change in clinical output
Auto-renewing contracts for indemnity, software, and premises account for 40 to 60% of private practice overhead and are the most common source of avoidable cost
A structured quarterly cost review takes less than two hours and typically identifies savings of 12 to 20% of total overhead within the first audit

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

What is a normal overhead level for a consultant?

It varies widely with specialty, sites and whether you employ a secretary. Track your own percentage year on year rather than chasing an average.

Is it worth switching indemnity cover?

Only on a like-for-like basis, and only once you are sure past work stays covered. The cheapest quote is not always the same cover. This is general information; take advice from a specialist medical indemnity broker or your defence body before you switch.

Should I outsource my secretary?

Compare cost per patient and the quality of patient contact. Many consultants keep one trusted person and outsource billing only.

How often should I do this?

A full review once a year, a one-hour margin check each quarter.

What about tax?

Ask your accountant which costs are allowable. That is a separate question from whether a cost is worth paying.

Last reviewed: 30 October 2026

Sources

GOV.UK Pay the data protection fee

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The short answer

Do it yourself: step by step

1Build a cost register3 hours · £0

2Work out your margin1 hour · £0

3Cancel what you do not use1 hour · £0

4Retender indemnity on a like-for-like basis2 to 4 weeks · £0

5Review room and clinic costs2 hours · £0

6Review secretarial and billing support2 hours, plus 2 weeks for quotes · £0

7Diary the renewals and the review30 minutes, then 1 hour a quarter · £0