A physiotherapist starting in private practice in London can expect gross session fees higher than NHS hourly rates, but matching a band 6 salary requires building a steady caseload of 15 to 20 private patients a week. Making the leap from the NHS to independent practice is a major decision, especially in a high-cost area like London. While private practice offers the potential for greater flexibility and a higher hourly yield, the security, paid leave and pension benefits of an Agenda for Change contract hold significant value. This guide breaks down the published data on NHS pay scales and private clinic fees to show exactly how the two paths compare.
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NHS band 6 pay in London
NHS salaries provide a clear, predictable baseline. According to NHS Health Careers, the Agenda for Change pay rates from April 2026 for a band 6 physiotherapist are £39,959 for those with under two years of experience, £42,170 for those with two to five years, and £48,117 for those with five or more years in the role. These figures represent the basic national salary.
In London, physiotherapists receive a high cost area supplement. For Inner London, this supplement is 20 percent of basic salary, with a minimum of £5,794 and a maximum of £8,746. For Outer London, the supplement is 15 percent, with a minimum of £4,870 and a maximum of £6,137.
To see what this means in practice, an experienced band 6 physiotherapist with over five years of service working in Inner London earns a basic salary of £48,117. Their 20 percent supplement would be £9,623, but because the supplement is capped, they receive the maximum of £8,746. This brings their total gross annual salary to £56,863. A newly qualified band 6 in Outer London earns a basic £39,959 plus a 15 percent supplement of £5,993, bringing their total gross starting salary to £45,952. These figures are guaranteed, reliable, and come with substantial employment benefits that are absent in self-employment.
Private practice revenue in London
Private practice earnings look very different from a salaried role because you are paid per session, not per hour of your working day. The revenue you generate depends entirely on the fees you set and the volume of patients you attract and retain. Knowing the market average helps independent physiotherapists decide how to price their services.
The HMDG Private Practice Barometer (checked September 2026) reports that the London average initial physiotherapy fee is £84.22, with an average follow-up of £62.15. Across the whole of the UK, the median initial assessment fee is £74 and the median follow-up is £63. These figures give a realistic picture of what a patient is typically willing to pay out of pocket in the capital.
If you see 20 patients a week in London consisting of five new assessments and 15 follow-ups, your gross weekly revenue based on those London averages would be £1,353.35. Over 46 working weeks (allowing time for holidays and sick leave), this generates £62,254 in gross revenue. However, gross revenue is not your take-home pay. Out of this total, you must deduct clinic rental, marketing, software, professional fees, and tax, which we will explore in detail below.
Comparing the options side by side
Deciding between a salaried NHS position and an independent private practice involves more than just looking at the top-line numbers. You are trading security for potential. The table below outlines the core differences between working as a band 6 in the NHS and running your own private caseload in London.
| Feature | NHS Band 6 (Inner London) | Independent Private Practice |
|---|---|---|
| Gross Income | £47,950 to £56,863 (guaranteed) | Variable based on patient volume and fees |
| Pension | Defined benefit NHS pension scheme | Private pension (entirely self-funded) |
| Leave and Sick Pay | Generous paid annual leave and sick pay | No paid leave, no paid sick days |
| Admin and Overheads | Covered by the NHS trust | You pay for room, marketing, and software |
| Working Hours | Usually fixed shifts or standard hours | Flexible, but evenings often required by patients |
Understanding these differences helps clarify why private fees must be significantly higher than an NHS hourly rate. A private practitioner has to fund their own holiday pay, sick cover, and business administration time out of their session fees.
Working out how many private patients you need
To understand the reality of private practice, it is helpful to look at a worked example using the published data. Suppose you want to match the £56,863 gross salary of an experienced band 6 physiotherapist in Inner London. You cannot simply divide £56,863 by a session fee, because your business overheads will consume a portion of your revenue.
If you aim for £56,863 in personal income before tax, you might need to generate around £75,000 in gross clinic revenue to cover an estimated 25 percent in overheads (such as room rental, booking software, and marketing). Using the London average follow-up fee of £62.15 from the HMDG Private Practice Barometer, generating £75,000 requires 1,206 appointments a year. If you work 46 weeks a year, that means you need to complete 26 paid sessions every single week.
Seeing 26 patients a week requires a strong, consistent flow of new enquiries. You must also account for cancellations and patients who do not attend. This is why many physios choose to read our guide on How much does private physiotherapy cost in London? to better understand how other local clinics structure their pricing models to ensure sustainability.
Hidden costs of running a private practice
When transitioning from the NHS, the administrative burden of running a business can be surprising. You are no longer just a clinician; you are also responsible for compliance, accounting, and marketing. Before you see your first private patient, there are several essential costs you must factor into your financial planning.
To operate safely and legally as an independent practitioner, you will need to arrange:
- HCPC registration: Your legal requirement to use the title physiotherapist, which requires an ongoing fee.
- Professional liability insurance: Often secured through membership of the Chartered Society of Physiotherapy (CSP), covering your clinical work.
- Data protection compliance: A registration fee paid to the ICO, as you will be processing sensitive health data.
- Accounting and software: Monthly subscriptions for practice management software (such as Cliniko or TM3) and accounting software to track expenses.
- Self-employment taxes: You must register for Self Assessment with GOV.UK and set aside a significant portion of your income for Income Tax and National Insurance.
These standing charges apply regardless of how many patients you see. Understanding these overheads is a core part of deciding your pricing, which we discuss further in our article on Getting private patients as an independent physio: what each channel really costs you.
Marketing and directory commissions
Finding private patients is the biggest challenge for independent physiotherapists. Your clinical skills matter most once the patient is in the room, but getting them there requires marketing, which comes at a cost. The HMDG Private Practice Barometer (checked September 2026) reports that UK private clinics spend an average of £1,800 a month on marketing. Clinics with under £100,000 in revenue spend an average of £515 a month, representing 11.2 percent of their revenue. The survey also notes that 64 percent of smaller clinics use Google Ads, yet only 25.8 percent of owners know their cost per acquisition.
Directory platforms are another common way to find patients, but their fee structures vary widely. For example, Treatwell charges a 35 percent commission on first bookings made by new clients it brings you, and 0 percent on repeat bookings. It also charges a 2.5 percent plus VAT processing fee when a client prepays online, alongside a monthly plan fee (checked September 2026). If you use Treatwell and a patient books the HMDG median UK initial assessment of £74, the 35 percent commission removes £25.90 straight away, leaving £48.10 before accounting for processing fees and VAT. We break this down further in Treatwell for physiotherapists: what a 35 percent first-booking commission really costs you.
In contrast, for physiotherapists using Limberly, the structure is different. Limberly is free to list and takes 15 percent of the price of each session booked through Limberly, for both initial appointments and follow-ups. On a £74 first appointment, the fee is £11.10. There are no monthly subscriptions and no separate processing fees for the practitioner, which makes forecasting your weekly overheads simpler.
The transition: balancing NHS and private work
Very few physiotherapists hand in their NHS notice and jump straight into full-time private practice. The financial risk is usually too high. A more sustainable approach is to reduce your NHS hours to three or four days a week while building your private caseload during evenings and weekends.
Maintaining a part-time NHS role offers several practical advantages during the transition:
- Guaranteed income: A stable base salary ensures your personal mortgage and bills are covered while private patient numbers fluctuate.
- Pension continuity: You continue to build years of service in the NHS defined benefit pension scheme.
- Clinical support: You remain connected to an NHS multidisciplinary team, which provides valuable peer support and ongoing professional development.
- Gradual growth: You can test your private pricing model and refine your local marketing without the pressure of needing immediate full-time revenue.
As your private clinic grows and your marketing begins to yield a steady cost per acquisition, you can gradually reduce your NHS hours further. Many practitioners also find that explaining how we check physios and highlighting their dual NHS and private experience builds immense trust with local private patients.
Frequently asked questions
Do I need to leave my NHS job to start a private practice?
No, you do not need to leave the NHS to start seeing private patients. Many physiotherapists work part-time in their band 6 or First Contact Physiotherapist role while renting a private room for one or two evenings a week. You must inform HMRC of your self-employed income and ensure your private work does not create a conflict of interest with your NHS trust.
How much do I need to charge to match my NHS salary?
Matching your salary depends on your overheads. If you aim to replace a £48,117 band 6 salary, you must generate significantly more than this in gross session fees to cover room rental, marketing, software, and your own sick pay and holiday time. Many independent physios aim for gross revenue at least 30 to 40 percent higher than their target take-home pay.
Are private physios paid for empty slots?
No, as an independent private physiotherapist, you only earn money when a patient attends a session and pays their fee. If a patient cancels late or fails to attend, and you are unable to enforce a cancellation fee, that time is unpaid. This is a key difference from salaried NHS work, where your hourly pay remains constant regardless of the clinic schedule.
What is the average price for a physio assessment in London?
Prices vary by borough and clinic setting, but the HMDG Private Practice Barometer (checked September 2026) reports that the London average initial physiotherapy fee is £84.22. Independent practitioners must balance this average against their local competition, their clinical experience, and the costs of renting premium clinic space in the capital.