How to Start a Private Occupational Therapy Practice in the UK

To start a private occupational therapy practice in the UK, you need five things in place before you see a single client. You need current HCPC registration, professional indemnity and public liability cover, registration with HMRC as self-employed (or a limited company), a data protection set-up that would survive a complaint, and a reliable way of staying safe when you visit people on your own. None of it is complicated. All of it is easy to put off until the week before your first booking.

After that come the harder questions, which are commercial rather than clinical. What will you actually do, who will pay you to do it, and how much do you need to charge to make it worth leaving a salaried job, or adding to one? This guide works through both halves in roughly the order most self-employed occupational therapists meet them.

The non-negotiables: registration, CPD and insurance

HCPC registration and CPD

Occupational therapist is a protected title, so you already know you need to be on the HCPC register. What changes when you go private is that nobody else is watching the details. No employer is logging your mandatory training, booking your appraisal or reminding you that renewal is due.

The HCPC audits a sample of registrants at each renewal. If you are picked, you need to show CPD that is continuous, varied, relevant to your current practice, and of benefit to the people you work with. Start a simple running record from your first week: what you did, what you learned, and how it changed your practice. A folder of certificates is not the same thing.

Your scope of practice matters more, not less, in private work. If your last ten years were in acute stroke, advertising yourself next month as a paediatric sensory specialist is a conduct issue, not just a marketing one. Check the current HCPC standards of proficiency and standards of conduct on the HCPC website and read them again with your new business in mind.

Indemnity and public liability

Having a professional indemnity arrangement is a condition of HCPC registration. In employment, that is usually covered by your employer. When you work for yourself, it is your job to arrange it.

RCOT membership includes professional liability insurance for members in general terms, and many independent OTs rely on it. Read the current terms carefully rather than assuming. In particular, check:

• whether independent or self-employed practice is covered, and whether you need to declare it
• the limits of cover and whether they suit the work you plan to do
• whether medico-legal reports, expert witness work and case management are included
• whether work with children, or work outside the UK, is covered
• whether public liability is included, and at what level

Some OTs find they need extra or specialist cover for expert witness or case management work. If you ever employ anyone, employer's liability insurance is generally a legal requirement. And tell your car insurer you are using the car for business travel, because a standard policy may not cover it.

Setting up the business side

HMRC and your business structure

Most OTs start as sole traders because it is the simplest structure. You register with HMRC for Self Assessment as self-employed, keep records of income and expenses, and pay tax and National Insurance on your profits. GOV.UK sets the deadline for registering, which is currently 5 October in your business's second tax year, but check the working for yourself pages for the current rules. Put money aside for your tax bill from your very first invoice. People who do not tend to learn this once, painfully.

Some OTs later move to a limited company, usually once income grows or they take on other therapists. That decision has tax, accounting and personal liability implications, so talk to an accountant. Making Tax Digital for Income Tax is being phased in for self-employed people above certain income levels, so check GOV.UK to see if and when it applies to you.

VAT is worth a separate look. Most health care provided by registered health professionals is exempt, but services whose main purpose is not health care, such as some reports prepared for legal proceedings, can be treated differently. If you plan medico-legal work, read HMRC's guidance on VAT for health professionals and get advice before your income approaches the registration threshold.

Terms of business

Open a separate bank account. Then write terms of business before you need them, covering what each service includes, cancellation and missed visits, payment terms, who the client is, and who receives and owns the report. That last point causes more friction than any other, especially when a solicitor, a family member or an employer is paying for an assessment of someone else.

Records, data protection and consent

You are now the data controller

In the NHS, information governance was somebody's department. In private practice, it is you. You will be processing health data, which is special category data under UK GDPR, so you need a lawful basis and an additional condition for processing it, a privacy notice you give to clients, and a clear retention policy. Most self-employed health professionals will also need to pay the data protection fee to the Information Commissioner's Office, which has a self-assessment tool on its website to confirm it.

The practical side matters as much as the paperwork:

• use encrypted devices and secure, password-protected storage for notes and reports
• do not send identifiable reports from a personal email account or over unencrypted messaging
• do not leave paper notes or devices in the car
• know how to recognise a personal data breach, and that serious ones may need reporting to the ICO within 72 hours

Your clinical records need to meet the same professional standard as before: accurate, dated, attributable and written at the time or as soon as possible afterwards. RCOT publishes guidance on record keeping, including retention periods, which are longer for children's records.

Consent and capacity

Being paid by someone does not give them the right to consent on another person's behalf. An adult daughter paying for her father's home assessment cannot consent for him if he has capacity. Where capacity is in doubt, you work within the Mental Capacity Act 2005 in England and Wales, with separate legislation in Scotland and Northern Ireland. With children, you need consent from someone with parental responsibility, and older children may be able to consent for themselves if they are competent to do so.

Record consent for the assessment and, separately, for who will receive the report. In medico-legal work, the person needs to understand that your report may go to the court and to the other side.

Setting your fees

Work backwards from what you need to earn, not forwards from what the nearest competitor charges. Add up your annual costs: HCPC fees, insurance, professional membership, CPD, supervision, equipment and measuring tools, software, accountancy, phone and mileage. Add the income you need. Then divide by the number of hours you can realistically bill.

That last figure is where most new practices go wrong. A ninety-minute home assessment might involve forty minutes of travel each way, an hour of phone calls and liaison, and three hours writing the report. If you price only the face-to-face time, you are working half your week for free. Decide how you will charge for each part:

• assessment time
• travel time and mileage
• report writing
• phone calls, emails and liaison with other professionals
• follow-up visits and reviews

Families generally prefer a clear package price for a home assessment and report. Solicitors and case managers are used to hourly rates and itemised invoices. Whatever you choose, publish it plainly. People comparing private occupational therapists look closely at what is included, and our guide on how to choose a private occupational therapist shows the questions they are told to ask.

Choosing a niche

Generalist private practice is possible, but it is hard to explain, hard to market and hard to insure well. Most successful independent OTs are known for something. Start from where you have genuine depth.

• Home assessments and equipment. Falls, bathing, stairs and getting home from hospital. Steady demand from families, often urgent, and usually a single visit plus report.
• Housing and adaptations. Recommendations for private adaptations, support with the Disabled Facilities Grant, rehousing reports. Needs real knowledge of building and of how your local councils work.
• Paediatrics. Sensory, motor and handwriting difficulties, and reports that inform an EHCP. Heavy demand, but you need paediatric experience, and schools and families will usually expect a DBS check. Self-employed practitioners cannot apply for an enhanced check directly, so check with the DBS or an umbrella body what level you are eligible for and how to obtain it.
• Medico-legal work. Expert witness reports on care and equipment needs. In civil cases in England and Wales, experts work under Part 35 of the Civil Procedure Rules, and their duty is to the court, not to whoever instructs them. Get expert witness training before you take your first instruction.
• Case management. Usually in personal injury, coordinating rehabilitation over months or years. See our guide to immediate needs assessments and case managers for how that world works.
• Work and ergonomics. Workplace assessments, return to work plans, reasonable adjustments.

Where referrals actually come from

Expect a slow start. Typical referral sources include:

• families paying for themselves, usually after a fall, a hospital stay or a long wait
• personal injury solicitors, both claimant and defendant, and case management companies
• local charities and condition support groups, who often signpost to people they trust
• schools and SENCOs, for paediatric work
• employers and occupational health providers
• other independent therapists who need an OT alongside them

GPs rarely refer privately but may signpost. Be cautious about any arrangement with equipment suppliers or builders that pays you, directly or indirectly, for recommending them. Even if it is legal, it undermines the independence that makes your report worth paying for.

Wherever referrals come from, people need to find and trust you. That means a plain description of what you do, the areas you cover, how you charge, and your HCPC registration number where anyone can check it.

Lone working and personal safety

HSE guidance on lone working applies to self-employed people too: you are responsible for assessing and managing your own risks. Set up a system before your first solo visit, not after your first frightening one.

• Share your diary with a trusted person and agree check-in and check-out times.
• Agree what happens if you do not check out, and agree a code phrase for trouble.
• Ask at referral about other people in the home, pets, and any history of aggression.
• Park so you can leave easily, keep your phone charged, and sit where your exit is not blocked.
• Leave if you feel unsafe. You can rebook, or decline.

Manual handling is part of this too. Assessing transfers alone in someone's home, without a second person or the right equipment, is a real risk to you and to them.

Reports, supervision and staying good

Your report is your product. Write it for the person who will act on it: a council grants officer, a judge, a SENCO, a worried son. Separate observation from opinion, give reasons for every recommendation, and make it clear what is essential and what is desirable.

Arrange regular clinical supervision with an experienced OT outside your own practice, and pay for it if you need to. Peer groups and RCOT specialist sections help with the isolation, which surprises many people. Have a written complaints procedure and a plan for what happens to your records if you suddenly cannot work.

Working alongside an NHS job

Many OTs start privately while keeping an NHS or council post. That is usually possible, but check your employment contract and local policy, and declare secondary employment if required. Keep the two strictly separate: never approach people you have seen in your NHS role, never use NHS equipment, time or systems for private work, and arrange your own indemnity, because your employer's cover will not extend to private clients. Watch your total working hours and your energy.

Where private occupational therapy fits, and where it does not

Private practice complements statutory services. It does not replace them, and you will serve clients best if you are honest about that. Statutory routes such as community equipment loans, NHS wheelchair services, council adult social care assessments and continuing healthcare all have their own processes. Some councils require their own OT assessment for a Disabled Facilities Grant, so ask before a family pays you expecting your report to unlock funding.

Know when to refer on. Medical concerns go to the GP, or to NHS 111 or 999 if urgent. Swallowing and communication sit with speech and language therapy. Physiotherapy leads on many mobility rehabilitation programmes. Your safeguarding duties do not end because the client is paying. Sometimes the honest answer to a family is that they do not need to pay you for this, and saying so builds a reputation faster than any advert.

Frequently asked questions

How much experience do I need before going private?

There is no legal minimum beyond HCPC registration, but you must stay within your scope of practice. Working alone without a team to check your reasoning is demanding, so many OTs build several years of post-qualification experience in their chosen area first.

Is the insurance that comes with RCOT membership enough?

For many independent OTs it is the starting point, but check the current terms against the specific work you plan to do, especially medico-legal, case management, paediatric and any overseas work. If in doubt, ask in writing.

Do I need to register with the ICO?

Most self-employed health professionals who hold client records will need to pay the data protection fee. Use the ICO's self-assessment tool to confirm your position.

Do I need to charge VAT?

Most health care from registered professionals is exempt, but some report work for legal purposes may not be. Check HMRC's guidance on VAT for health professionals and take advice from an accountant.

Can I work privately while employed by the NHS?

Usually yes, with your employer's knowledge and within your contract and local policy. Keep your private work completely separate and have your own indemnity in place.

Do I have to join a directory to work privately?

No. Directories are one way for people to find you, alongside your own website, professional networks and word of mouth. Nothing requires you to be listed anywhere other than the HCPC register.

Next steps

If you are setting up and want families to find you, read about listing your practice, see how we explain functional assessments and reports to the people searching for them, and choose an area below to see who already practises near you.