Ethics in Private Practice

Ethical Challenges in Commercial Settings

Private practice presents unique friction points that can compromise clinical judgment: 

• Direct Financial Relationship: Patients are paying customers, introducing commercial pressure that may influence clinical decisions. 
• Marketing Pressure: Commercial incentives can tempt practitioners to oversell procedures or underinform patients about risks and alternatives. 
• No Institutional Safety Net: Smaller private practices often lack the institutional governance and oversight of the NHS, requiring ethics to be self-policed and deeply integrated. 
• Elevated Litigation Risk: Patients in private practice are more likely to sue, often seeking higher claims for damages.

Applying the Four Pillars of Medical Ethics

All clinical decisions must be balanced against the four pillars of medical ethics: 

1. Autonomy: Requires respecting patient choice through informed decision-making, including disclosing NHS or other alternatives. 
2. Beneficence: Clinicians must prioritise the patient’s welfare and recommend what is clinically best, even if it is not the most profitable option. 
3. Non-Maleficence: This extends to avoiding financial and psychological harm, such as proceeding when a patient cannot afford treatment or setting unrealistic expectations. 
4. Justice: Demands fair and transparent pricing with no hidden fees, and equitable treatment regardless of the amount paid. 

Seek Informed Consent

Gold standard consent must be voluntary (free from pressure), informed, and ongoing (able to be withdrawn at any time). Disclosure must cover common and serious risks, realistic benefits and outcomes, NHS alternatives, the clinician’s qualifications, and total costs, including those for potential complications. 

Documentation must record the conversation with the patient, detailing risks, expectations, alternatives, and the opportunity to reconsider, not just a signature. The use of AI scribes must be disclosed to the patient. Clinicians are not obliged to treat if it is not in the patient’s best interest, but they must document the clinical and ethical reasoning for refusal. 

Conflicts of Interest and Confidentiality

Common conflicts include financial incentives to overtreat and undisclosed ownership in referral facilities. For referral fees from testing providers, the safest option is to decline the fee and refer based purely on quality and cost. 

If working in both NHS and private practice, NHS commitments take precedence, and clinicians must be transparent with their employer about private practice. 

For confidentiality, if an insurer requests clinical records, the clinician must first contact the patient, explain the request, and obtain written consent before disclosing only the minimum necessary information. Disclosure without explicit patient consent is only permissible for legal obligations (e.g., court orders or notifiable diseases) or public interest to prevent serious harm. 

Marketing and Regulatory Requirements

Marketing is regulated by bodies including the ASA, MHRA, GMC, GDC, and CMA. Practitioners must avoid misleading claims or guarantees, include disclaimers, and must not use pressure-selling tactics like creating artificial urgency. 

Since 2024, holding indemnity that covers the full scope of private practice is a mandatory GMC and GDC requirement. Policies must be checked for adequate limits for high-damages private claims and inclusion of all provided procedures.

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