Going Self-Employed

By Victoria Vilas / 29 Dec 2016

Operations and marketing manager Victoria Vilas details the points to consider when starting your own business

The private healthcare industry offers medical professionals the chance to develop a career in specialisms outside of the NHS remit. It allows them to setup independent practices and develop a personal or company brand, and to move into an industry where earnings are not subject to public sector bandings or caps. Aesthetic medicine is an area of private healthcare that is growing substantially, and one that offers many opportunities for talented and enterprising clinicians.

Working as an aesthetic practitioner gives you the chance to continue medical practice, but also perform treatments that require more of a personal touch and artistic flair than conventional medicine. The independence and earning potential of being self-employed may appeal if you think you have the drive to develop and manage your own business, and the skills and experience to grow a loyal patient base. Having the freedom to choose when and where you work, and taking home the profits of your hard work, can make for a prosperous career with a great work/life balance, but if you don’t take the care needed to manage all elements of your business efficiently and legally, then you may never realise that dream. In a competitive market, it is essential to get off on the right foot if you want to develop a solo career that flourishes. If you get the details right when you first set up, you will find it far easier to get into a regular working routine, and create your own structure and schedule that helps you to manage your workload efficiently, prioritise effectively, and satisfy patients while staying on top of administration and operational tasks.

Define the career you want and make a business plan

To be a self-employed worker in any field, even if it is not full time, you must define your employment status, notify HMRC, and then comply with the regulations associated with that status. Working independently can take more than one form, and the tax office will expect you to declare how you work, and what you earn from it. So, the first thing to do is to decide what your self-employment will involve. Do you want to be a sole trader, performing toxin and filler injections on your own patients from a treatment room that you will hire in a multi-disciplinary medical practice? Would you prefer to be a freelance contractor, visiting clinics in your area to perform treatments on their clients? Do you want to set up your own business, perhaps with a partner, find premises and hire other staff members to create a company? Your decision is likely to be based on the funding you have available, the existing network of patients and colleagues you could take with you, and the time and effort involved in working out the logistics. Once you have an idea of what is both possible and realistic, you can start your business plan. Make some calculations to work out how many hours or days you need to work, and at what rate, to get to the income level you require.

  •  Take into account the costs you may incur, consider the potential opportunities and problems you may encounter and think of how you could hypothetically deal with them.
  • Make a list of the legal requirements for operating your business and the paperwork you need to complete.
  • Start your administrative set-up, including a calendar with dates for tax returns and payments, insurance premium and regulatory body renewals, as well as potential patient consultation and treatment slots.

Register your status with HMRC

If all you know is that you want to work for yourself, then setting up as a sole trader1 is the quickest and easiest way to start a business on your own.2 It is essential to register as self-employed3 with HMRC and follow the rules for declaring your taxable income and submitting your own National Insurance (NI) contributions4 as soon as you start working for yourself, because you may be subject to penalty charges if you submit late tax returns, or fail to make payments on time.5 If your employment status changes from being another company's employee to being self-employed, you must notify HMRC so they can make sure you are paying the right levels of Income Tax6 and NI.7 When you are self-employed, paying your contributions is solely your responsibility, and you will be liable for penalty charges for late or incorrect payments, not your employer.8 Once your business is established, you may wish to set up as a limited company,9 meaning you pay less personal tax, and will be able to take additional money out of the business as dividends.10 You will need to register your business at Companies House, which is the UK companies register;11 appoint directors, which may be yourself or a business partner; complete company accounts, your annual tax return and pay corporation tax. You may decide not to this for reasons including, more complex, time consuming accounting and administration requirements, more expensive accountancy costs, and information relating to the owner of the company and the company itself that are displayed on public record.12

If you do wish to set up your own limited company, then HMRC does not consider you ‘self-employed’ as such, but rather the director and employee of your own company (Figure 1). After registering your business at Companies House, you must also register for Corporation Tax.13 As a director, you will need to fill in an annual selfassessment form which includes information on all sales or takings, and purchases and expenses,14 and you will pay your income tax and NI as an individual and employee of your company, using the PAYE system.15 If you are not sure whether you should set up as a sole trader or limited company, accountants who deal with small businesses will be able to offer you advice.16 If you do not think you can manage to keep on top of your business records, returns and accounting, then consider using the services of a bookkeeper or accountant.17 

Check you have the right certifications and get insured 

Though this may be stating the obvious, to work as an independent aesthetic practitioner in the UK, you must be registered with regulatory bodies, have completed certified training courses, and have professional indemnity insurance that includes medical malpractice cover. Doctors and surgeons must be registered with the General Medical Council (GMC), nurses with the Nursing and Midwifery Council (NMC) and dentists with the General Dental Council (GDC). If you have been a medical practitioner abroad, and do not yet have UK registration, you must apply for and receive this to practise legally in the UK.18 If you are an NMC registered nurse who has trained in injectable procedures, you will also need to have completed the V300 Non-Medical Prescribing course to be able to prescribe and use prescription-only medications such as botulinum toxin legally, without the presence of another qualified prescriber.19 Though you may be a highly skilled clinician, you cannot guarantee that you will never face a complaint or claim against you, whether it is justified or otherwise. If you have professional indemnity insurance then you will be covered for a range of scenarios, including mistakes and negligence, breach of confidentiality, and more. If you are not covered, you could face having to pay thousands of pounds in legal fees and compensation to defend a claim.

When working for yourself, there are other scenarios to consider with regards to insurance cover. Professional indemnity may protect you against a malpractice claim, but it does not cover you for unfortunate personal circumstances. If you are a sole trader and fall seriously ill or have an accident that prevents you from working, then you could end up in financial difficulty at the same time as having to deal with the stress of your situation. It is wise to arrange Income Protection Cover to give you peace of mind, so you know that you and your family will be covered if you are unable to work for a long period.20

Market your services and develop your patient list

As a self-employed practitioner, you will be responsible for your own PR and marketing, and generating your own business. You may already have patients, but it’s likely that you’ll need to increase your patient base if you are giving up a permanent job to go self-employed. A huge number of potential patients are likely to search for practitioners and clinics online, so digital marketing is very important. This doesn’t mean that you have to allocate funds for an expensive multi-functional website and online advertising, as you can have an online presence even with a small budget. It is a good idea to launch your own website, as this will give you the space to list your services and prices, supply your contact details and address, display patient testimonials and treatment images, and add an air of professionalism. Sites such as Wix.com and Moonfruit.com offer the tools to build a basic website for free, and to host your site and keep it online for as little as Åí3 per month. You will need to pay for a domain name to give your site its own unique title, but these can be less than Åí10 for a whole year. If you enlist the help of a professional to get your website designed, built and online, you may be looking at costs of Åí500 to Åí3,000, but this can be a worthwhile investment if you're not tech-savvy and want a professional-looking site.21 As many potential patients are likely to be social media users, it’s also wise to have a business page on Facebook, a Twitter account, and perhaps an Instagram account for any before-and-after pictures that your patients have consented to you using for marketing communications. Social media accounts are a great way to advertise your business for free, and collect positive reviews and comments from patients. Dedicating just a few hours per week to posting on your social media accounts can be an easy way to market your services and stay in touch with trends. 

Despite the prevalence of digital marketing, never underestimate the power of word-of-mouth advertising. If a patient has a fantastic treatment experience with you, they are likely to share their feelings and recommend your services, but also return to you as a regular patient. You may have a great technique, but in order to gain and keep patients, you will also need to ensure your customer service is flawless from start to finish.As a self-employed practitioner, you will be responsible for your own PR and marketing, and generating your own business. You may already have patients, but it’s likely that you’ll need to increase your patient base if you are giving up a permanent job to go self-employed. A huge number of potential patients are likely to search for practitioners and clinics online, so digital marketing is very important. This doesn’t mean that you have to allocate funds for an expensive multi-functional website and online advertising, as you can have an online presence even with a small budget.

It is a good idea to launch your own website, as this will give you the space to list your services and prices, supply your contact details and address, display patient testimonials and treatment images, and add an air of professionalism. Sites such as Wix.com and Moonfruit.com offer the tools to build a basic website for free, and to host your site and keep it online for as little as Åí3 per month. You will need to pay for a domain name to give your site its own unique title, but these can be less than Åí10 for a whole year. If you enlist the help of a professional to get your website designed, built and online, you may be looking at costs of Åí500 to Åí3,000, but this can be a worthwhile investment if you're not tech-savvy and want a professional-looking site.21 As many potential patients are likely to be social media users, it’s also wise to have a business page on Facebook, a Twitter account, and perhaps an Instagram account for any before-and-after pictures that your patients have consented to you using for marketing communications. Social media accounts are a great way to advertise your business for free, and collect positive reviews and comments from patients. Dedicating just a few hours per week to posting on your social media accounts can be an easy way to market your services and stay in touch with trends. Despite the prevalence of digital marketing, never underestimate the power of word-of-mouth advertising. If a patient has a fantastic treatment experience with you, they are likely to share their feelings and recommend your services, but also return to you as a regular patient. You may have a great technique, but in order to gain and keep patients, you will also need to ensure your customer service is flawless from start to finish.

Keep a check on your budgets and expenditure

When you are self-employed, you are responsible for generating your own business, and your own income. There is no basic salary to fall back on, or a redundancy payout if your work dries up. Being self-employed can be daunting as your income may fluctuate. Make sure you have insurance that covers the worst eventuality, but also try and budget carefully. Create a budget document on paper, on a spreadsheet, or with online bookkeeping tools, and track all of your revenue and expenses.22 Include projected cashflow, fixed and variable costs, and revenue forecasts, and most importantly, be realistic with your estimations.23 When you have your own private patients, there is no doubt that you will need certain stock and equipment in order to do your job. You may not have the funds to invest in a multi-use laser device right now, but if you are performing injectable treatments, skin peels, or microneedling, then you will need the relevant products in stock, and supplies for preparing your treatment room to create a hygienic, comfortable environment for your patient. When it comes to training, even if you work freelance in other clinics, you also should expect to pay for your own training, be it in new treatments, or advanced courses to further develop existing skills. Clinics may invest in training for permanent members of staff, but they cannot guarantee that contractors will stay long enough to make paying for expensive training courses worthwhile.

Make contingency plans

There is no employment contract allocating you annual leave, and no employer to take responsibility for covering your work when you are away when you are self employed. It will be up to you to schedule holiday at a time when it is convenient for your business, but if you get ill, you may have to cancel bookings. It’s not all negative though. If you’re feeling unwell, you don’t have to worry about whether your employer will be understanding, and you don’t have to ask for anyone’s permission to book a holiday on certain dates. With some thought on scheduling and good communication with your patients, you’ll be able to take breaks without too much hassle. If you’re concerned about undertaking everything on your own, you could also consider going into official partnership with another practitioner, so you have each other to bounce ideas off, to cover one another during holidays or illnesses, and to be able to increase your capacity for patient bookings. It is always a good idea to have a back-up plan, or to at least think about putting aside funds to cover your essentials if you happen to have a lull in custom at any point. Whichever route you choose, despite the daunting set of tasks required to set up your solo endeavour, once you have completed the administration and started on your new path, working for yourself can be incredibly rewarding and worthwhile.


References

1. Set up as a sole trader (UK: GOV.UK, 2016) <https://www.gov.uk/set-up-sole-trader>[31.10.2016]


2. How to register as a self employed sole trader or freelancer (UK: Startups, 2016) <http://startups.co.uk/how-to-register-as-a-self-employed-sole-trader-or-freelancer/>


3. Working for yourself (UK: GOV.UK, 2016) <https://www.gov.uk/working-for-yourself>


4. Register for and file your Self Assessment tax return (UK: GOV.UK, 2016) <https://www.gov.uk/log-infile-self-assessment-tax-return/register-if-youre-self-employed>


5. Help with your Tax Return: Deadlines and Penalties (UK: TaxAid, 2016) <http://taxaid.org.uk/guides/taxpayers/tax-returns/late-tax-returns>


6. Tax for the self-employed (UK: Which?, 2016) <http://www.which.co.uk/money/tax/guides/tax-for-theself-employed/self-employed-income-tax/>


7. Self-employed National Insurance rates (UK: GOV.UK, 2016) <https://www.gov.uk/self-employednational-insurance-rates>


8. Tax and National Insurance when you’re self employed (UK: The Money Advice Service, 2016) <https://www.moneyadviceservice.org.uk/en/articles/tax-and-national-insurance-when-youre-selfemployed>


9. 10 advantages of running your business as a limited company instead of being self employed (UK: Bytestart, 2016) <http://www.bytestart.co.uk/limited-company-advantages.html>


10. Should I be self-employed or a limited company? (UK: ihorizon, 2014) <http://ihorizon.co.uk/selfemployed-limited-company/>


11. Companies House: About Us (UK: GOV.UK, 2016) <https://www.gov.uk/government/organisations/companies-house/about>


12. Advantages and disadvantages of limited company formation, (UK: Company Formations, 2015) <https://www.yourcompanyformations.co.uk/blog/advantages-and-disadvantages-of-limitedcompany-formation/>


13. Corporation Tax (UK: GOV.UK, 2016) <https://www.gov.uk/corporation-tax>


14. Business records if you’re self-employed (UK: GOV.UK, 2016) <https://www.gov.uk/self-employedrecords>


15. PAYE and payroll for employers (UK: GOV.UK, 2016) <https://www.gov.uk/paye-for-employers>


16. I’m starting up my first small business. Should I hire an accountant or do my own sums? (UK: This is Money, 2013) <http://www.thisismoney.co.uk/money/smallbusiness/article-2438577/Im-starting-smallbusiness-Should-I-hire-accountant-sums.html>


17. How much do accountants charge? (UK: Ainsworth Accountants, 2013) <http://accountant-prestonlancashire.co.uk/accounting-tax-bookkeeping-services/how-much-do-accountants-charge> [31.10.2016]


18. Information for overseas doctors (UK: Health Careers, 2016) <https://www.healthcareers.nhs.uk/i-am/outside-uk/information-overseas-doctors>


19. Information for Nurses interested in entering Aesthetics (UK: British Association of Cosmetic Nurses, 2016) <http://www.bacn.org.uk/education/entering-aesthetics>


20. Do you need income protection insurance? (UK: The Money Advice Service, 2016) <https://www.moneyadviceservice.org.uk/en/articles/do-you-need-income-protection-insurance>


21. How much does a website cost in 2016? (UK: Expert Market, 2016) <http://webdesign.expertmarket.co.uk/how-much-does-website-cost>


22. The five minute business ready budget guide (UK: QuickBooks, 2016) <https://www.quickbooks.co.uk/r/business-planning/the-five-minute-business-ready-budget-guide/>


23. James Caan, How to budget for startup success (UK: QuickBooks, 2016) <https://www.theguardian.com/small-business-network/2013/aug/14/how-to-budget-business-startup-success>


24. Sole trader v. limited company: key tax & legal differences (UK: Ross Martin, 2016) < http://www.rossmartin.co.uk/starting-in-business-77750/140-sole-trader-v-limited-company-key-tax-a-legaldifferences>


Further reading

• Set up a business (UK: Gov.uk, 2016) <www.gov.uk/set-up-business>

• Working for yourself (UK: Gov.uk, 2016) <www.gov.uk/working-for-yourself>

• Self-employment (UK: RCN, 2016) <www.rcn.org.uk/get-help/rcn-advice/self-employment

• Self-employment: checklist (UK: Citizens advice, 2016) <www.citizensadvice.org.uk/work/selfemployed-or-looking-for-work/self-employment-checklist/>

• Self-employment (UK: Money Advice Service, 2016) <www.moneyadviceservice.org.uk/en/categories/self-employment>

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