Private Practice Setup for Consultants | Clinic Setup | Glaxtons

Glaxtons Consulting

For consultants and clinician founders

Setting up your own practice, start to finish

Company structure and asset protection, funding and the lender pack, the shareholders' agreement with your partners, the lease negotiation, CQC registration, the fit-out programme, and then the NHS contract work that fills your lists. One adviser accountable for the whole programme, so it does not run through your clinic days.

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The problem is not clinical, and that is why it is hard

Consultants opening a practice are excellent at the thing the practice does and are being asked, usually for the first time, to be a property negotiator, a borrower, a company structurer, a regulatory applicant and a construction client. Each of those has its own professionals who do it full time, and you are meeting them across a desk while running a clinical job.

The individual pieces are gettable. A solicitor will draft the lease. An accountant will report on the structure. A broker will approach lenders. What nobody in that group owns is the programme, and the programme is where these projects fail, because the failures are almost always dependencies between parties rather than mistakes inside any one of them. Equipment ordered late because funding completed late. Registration started after the build rather than alongside it. A lease signed by an entity the lender then asks you to change.

Once the lease completes, rent runs whether or not you can legally see patients. From that day the programme is the commercial priority, and it needs somebody accountable for it who is not also holding a clinic list.

The seven workstreams

In the order they should start, which is not the order most people do them in. They overlap heavily: the ones that run in sequence rather than parallel are the ones that add months.

Funding and lender packs

Most consultants are turned down not because the venture is weak but because the submission does not answer what a credit committee actually asks. We build the business plan, the forecasts to the lender's own template, and the security and covenant narrative that sits alongside them.

The trap: Treating the forecast as an optimism exercise. Underwriters read hundreds of these and discount hockey sticks automatically. A plan that models a slower ramp, states the assumptions behind the referral pipeline, and shows the venture still services the debt at a pessimistic case is more fundable than one showing a better headline. Lenders are not buying your upside, they are pricing your downside.

Funding and lender packs in detail

Company structure and asset protection

The structure you incorporate at the start determines whether a future clinical claim can reach the assets you spent a career building. Getting it right costs very little at incorporation and is expensive or impossible to unwind later.

The trap: Letting the lender design your structure. A broker or underwriter will sometimes push for the entity that is simplest to underwrite, which is often the one holding the existing assets and track record. That is rational from their side and can be the wrong answer for you, because it collapses the separation between the family balance sheet and the venture. The right response is not to refuse, it is to ask which specific underwriting concern the request solves and to solve it another way, usually with a guarantee rather than by moving the assets inside the borrowing entity.

Company structure and asset protection in detail

Shareholders' agreements for clinical partnerships

Most clinical partnerships are formed between colleagues who trust each other, which is exactly why the agreement gets postponed. It is needed for the case where that changes, and it has to be written while everyone is still friendly.

The trap: Copying a template off the internet, or leaving it until after the funding completes. A generic agreement will not address clinical practice specifics such as what happens to a shareholder who loses registration or is suspended pending investigation, and lenders often require the agreement to be in place before drawdown. Leaving it late means drafting it under deadline pressure, which is when people concede terms they later regret.

Shareholders' agreements for clinical partnerships in detail

Premises and commercial lease negotiation

A clinic lease is a fifteen-year decision made in a fortnight, usually against an agent acting for the landlord who negotiates leases full time. The headline rent is rarely where the money is.

The trap: Negotiating the rent and conceding everything else. Agents concede on headline rent readily because it is the number the client is watching, then recover it through the uplift basis, the service charge, the repairing obligation and the reinstatement clause. A rent-free period is worth less than a capped service charge over a fifteen-year term, and dilapidations at the end can cost more than a year's rent if the repairing obligation was accepted without amendment.

Premises and commercial lease negotiation in detail

CQC registration for a new practice

CQC registration is a gate, not a formality. It determines your opening date, and an application that goes back for clarification can add months to a programme where the rent is already running.

The trap: Starting the application when the building work finishes. Registration timelines are measured in months, and rent starts whether or not you can legally see patients. The application should be prepared in parallel with the fit-out, which requires knowing what the finished premises will look like and being able to evidence it before it exists.

CQC registration for a new practice in detail

Fit-out and project management

Once the lease is signed the rent runs whether or not you are treating patients. From that point the programme is the commercial priority, and somebody has to own it who is not also running a clinic list.

The trap: Assuming the contractor manages the programme. A contractor manages their own works. Nobody except you is accountable for the fact that the equipment has a sixteen-week lead time, the registered manager has not been appointed, and the landlord has not approved the drawings. Those dependencies sit between suppliers, which is precisely where programmes fail.

Fit-out and project management in detail

NHS contracts and Patient Choice

A private clinic that only takes self-pay and insured patients is leaving the largest buyer in the country out of its pipeline. NHS-funded work through Patient Choice and ICB contracts is where a new practice builds volume, and it is a procurement problem rather than a clinical one.

The trap: Waiting until the clinic is open and quiet. Accreditation and bidding both have lead times, and the point at which you notice you need NHS volume is months after the point at which you should have started. This workstream should begin during the build, not after opening.

NHS contracts and Patient Choice in detail

The sequencing errors that cost the most

Structure decided last. It has to be first. Incorporation, the lease and the funding all lock it in, and unwinding a lease signed by the wrong entity is difficult once a landlord has taken the covenant into account.

CQC registration started after the fit-out. Registration runs in months and rent runs from completion. It should be prepared in parallel with the build.

Equipment ordered after funding completes. Lead times are frequently the critical path. If the order waits for drawdown, the opening date moves.

NHS accreditation left until the clinic is quiet. Patient Choice accreditation and ICB bidding both have lead times. The moment you notice you need NHS volume is months after the moment you should have started.

The lender designing your structure. An underwriter will sometimes ask for the entity that is simplest to underwrite, which can be the one holding your existing assets. The answer is not to refuse but to ask which specific concern it solves, and to solve it with a guarantee instead.

Setting up a private practice: common questions

What does it cost to set up a private practice?

The capital requirement varies enormously with premises and equipment, but the components are consistent: fit-out, equipment, working capital to breakeven, professional fees and contingency. A consulting-room practice can be modest. A practice with treatment or diagnostic facilities is a substantially larger project and usually needs external funding. The right first step is to size the capital requirement properly, because it determines whether you are self-funding or borrowing, and that changes the structure you should incorporate.

What is the right order to do things in?

Structure first, because incorporating the wrong entity is expensive to unwind and the lease and the funding both lock it in. Then funding and premises in parallel, since each informs the other: the rent and rent-free period feed the forecasts, and the lender wants firm terms to underwrite. CQC registration and the fit-out run together, not sequentially. NHS accreditation and bidding start during the build, not after opening. The most common and most costly sequencing error is leaving CQC registration until the building work finishes.

Do I need a separate company for the property?

Where property, significant fit-out or expensive equipment is involved, a two-company structure is common and often right: an operating company that trades and carries the clinical risk, and a separate entity holding the lease and the assets, so a claim against the trading company cannot reach them. For a low-capital consulting-room practice one company can be adequate. The decision should be deliberate and taken before incorporation.

Can a consultant get funding to open a clinic?

Generally yes. Lenders are comfortable with clinician-led healthcare ventures because the covenant is strong and the earnings are demonstrable. What decides the outcome is usually the quality of the submission rather than the strength of the borrower: a capital requirement broken down line by line, forecasts built on stated assumptions and modelled at a pessimistic case, and clarity on which entity borrows and which trades.

How long does it take from decision to opening?

Realistically nine to eighteen months for a practice involving premises and regulated activity, and the constraints are rarely clinical. Funding, lease negotiation, CQC registration and equipment lead times all run in months, and they interlock: a delay in funding delays equipment orders, which delays the fit-out, which delays registration. The projects that open on time are the ones where these ran in parallel from the start rather than in sequence.

Why use a consultancy rather than a solicitor and an accountant?

You will need both, and we work alongside them rather than instead of them. What neither is positioned to do is own the programme across all of it: the solicitor drafts the lease you negotiate, the accountant reports on the structure you chose, and neither is accountable for whether the equipment was ordered in time for a registration date that depends on a landlord consent. That coordination is the actual work, and it is where these projects slip.

What this looks like in practice: read the anonymised case study of a consultant-led practice setup, covering the structure decision, the lender negotiation and the sequencing.

Reviewed 22 August 2026. Regulatory requirements change, and CQC guidance in particular should be confirmed against the current published position before you plan around it. Nothing on this page is legal, tax or financial advice.

Tell us where you are in this

Whether you have a site in mind, partners agreed, or are still deciding whether the numbers work. A director replies, and the first conversation is about sequencing rather than fees.