How Many Patients a Week Do I Need to Replace My NHS Salary?

A Band 6 physiotherapist on £42,170 needs roughly 16 private sessions a week at the UK median follow-up fee to match their NHS salary in gross fees, and around 20 a week to match the whole employment package.

That gap between the two numbers is the entire article.

Most people leaving the NHS calculate against the figure on their payslip. That figure is the smallest part of what you are giving up, and planning against it is how practitioners end up eighteen months in, technically profitable, and quietly worse off.

What are you actually replacing when you leave the NHS?

The 2026/27 Agenda for Change scales, effective 1 April 2026 after a 3.3% award:

Now the parts that are not on the payslip.

Annual leave. Around six weeks plus bank holidays, paid. In private practice an empty week earns nothing, so this is not a perk you lose, it is roughly a ninth of your year that now has to be funded by the other eight ninths.

Sick pay. NHS occupational sick pay is generous and rises with service. Self-employed, a fortnight with flu costs you a fortnight of fees, and the rent still goes out.

Employer pension contribution. This is the largest hidden item by a distance, and it is money paid on your behalf that never appears in your gross salary. Look up the current employer contribution rate for the NHS Pension Scheme rather than taking a number from an article, because it has changed repeatedly. Whatever it is, you now pay both halves.

Employer National Insurance, paid on top of your salary. Also yours now, in a different form.

Everything unglamorous. Indemnity, CPD, registration, supervision, equipment, admin time. All previously absorbed by the trust.

The honest planning number is not your salary. It is your salary plus leave cover plus the pension contribution you must now make yourself. For most practitioners that lands somewhere between 20% and 35% above the payslip figure, depending mostly on how much you value the pension.

The arithmetic

Same model as our pricing guide, run backwards. Every benchmark comes from the UK Private Practice Barometer 2026, a survey of 715 UK clinic owners.

Sessions per week = target income
                  / (fee x (1 - DNA rate) x working weeks x margin)

The four inputs, with realistic values rather than hopeful ones:

Fee. The UK median physiotherapy follow-up is £63. Use your regional figure, not the national one. Most of your appointments are follow-ups, so this is the number that matters, not your initial assessment fee.

DNA rate. 6.3% for clinics running appointment reminders. Assume you will have some.

Working weeks. 46, allowing six weeks off. If you plan for 52 you are planning never to take a holiday, and 39% of clinic owners in the survey already report not taking adequate leave.

Margin. Median profit margin across UK private practice is about 20% after room rent, insurance, software and admin. This is the input people forget entirely. Gross fees are not income.

How many private sessions a week equal each NHS band?

Assuming £63 a session, 6.3% DNA and 46 working weeks, and showing both targets: matching the salary alone, and matching salary plus a 30% uplift for the package you have left behind.

These are gross fee sessions, before your own costs, which is why the salary column looks so achievable. A Band 6 clinician seeing 15 patients a week grosses about £41,000. They do not take home £41,000.

Which brings us to the number that actually decides this.

Why gross fees are not income: the margin trap

Run it the other way. Twenty sessions a week at £63, less 6.3% DNA, over 46 weeks, is £54,300 of realised fees. At the median 20% margin, that is not a £54,000 income.

The Barometer's answer to what people actually take home: median owner earnings across all UK clinic owners are £50,000, and for solo operators doing more than 90% clinical work, £36,000.

Read that again alongside the pay bands. The median solo practice owner earns less than a Band 6 physiotherapist at the top of their scale, and less than a Band 7 at entry. They also carry the risk, the admin, the empty weeks and no pension contribution from anyone.

This is not an argument against going private. It is an argument against going private on the assumption that the money is automatically better. It is better at the top of the distribution and worse at the median.

What actually closes the gap

If the median solo owner takes home £36,000, the interesting question is what the ones earning double are doing differently. The survey is fairly clear, and it is not fees.

Utilisation. Average diary utilisation is 72.3%. The gap between 72% and 85% of a 28-slot week is roughly four extra appointments, worth about £10,900 a year gross. That is the single largest number available to a solo practitioner, and it costs nothing but a fuller diary.

Sessions per episode of care. Median 5.0, top decile 8 or more. Three extra sessions per patient at £63 is £189 each, with no acquisition cost.

Rebooking rate. Average 74%, top decile above 90%.

Not pushing past 80% utilisation. Wait times rise sharply above it, 5.5 days against 2.6 days at 50 to 70% occupancy, and long waits send new patients elsewhere. Full is not the same as optimal.

Notice that three of the four are retention, not acquisition. Getting to a genuine NHS-equivalent income is mostly about patients coming back, not about finding more of them.

Should you go part time before going private?

The most sensible version of this plan is rarely the dramatic one.

Two clinical days a week alongside a reduced NHS contract, at 8 sessions a day, is 16 sessions a week. On the table above, that covers a Band 5 salary before you have given up anything. It also means your pension keeps accruing, your sick pay still exists, and you find out whether you can actually fill a diary before that question has consequences.

The practitioners who struggle are usually the ones who resigned first and built the caseload afterwards. A private diary takes months to fill: the Barometer puts median cost per patient acquisition at £25 and finds referral routes like GPs and consultants build over months rather than weeks.

Work out your own number

Or do it by hand:

1. Take your current gross salary
2. Add 20% to 35% for pension, leave and sick pay, depending on how much the pension matters to you
3. Divide by your regional follow-up fee from the pricing guide
4. Divide by 0.937 to allow for no-shows
5. Divide by 46 working weeks
6. That is your sessions per week to match the package on gross fees
7. Then decide what your costs are, and how much of that gross you actually keep

If the number that comes out is under 20 sessions a week, this is very achievable. If it is over 30, you are either underpriced for your region or planning to work more than you did in the NHS for the same money, and it is worth knowing that before you hand in your notice rather than after.

Sources: NHS Employers, Agenda for Change pay scales 2026/27. UK Private Practice Barometer 2026 (HMDG, 715 UK clinic owners, surveyed August to November 2025) for fee, utilisation, DNA, retention, margin and owner earnings benchmarks, all self-reported. Pay scales and pension contribution rates change annually; check current figures before relying on them.

Related: How much should a physiotherapy session cost in the UK? · What it costs to set up a private practice in year one · Sole trader or limited company?