Do I have to register for VAT on medico-legal reports?

Only if your taxable turnover, which is the income that is not exempt, goes over £90,000 in any rolling twelve months. The trap is assuming all medical income is exempt and therefore never counting it. Medico-legal work is standard rated because its purpose is to help a court decide, not to treat the patient.

Can I put my NHS work through my private practice company?

No. An NHS consultant post is an employment, and pay from it is employment income taxed under PAYE. That was settled in Mitchell and Edon v Ross and it has not moved since. Anyone suggesting otherwise is describing something HMRC will unwind.

My private income is small. Is it worth having an accountant at all?

Below a few thousand pounds a year, often not, and we will tell you that. The point at which it starts paying for itself is usually when payments on account begin, or when the VAT position stops being obvious.

Accountants for Consultants in Private Practice

Written and reviewed by the Medical Accountants editorial team. Last reviewed 24 July 2026.

A consultant with a private list is running a business next to a job. The NHS side is employment income taxed at source. The private side is a trade, with its own records, its own expenses, its own possible VAT position and its own tax to find twice a year. HMRC treats them as two different things, and a court decided that as far back as 1961.

The work here is keeping those two apart cleanly enough to be defensible, and putting them back together once a year in a way that produces a number you can plan around.

Private Billing and Bookkeeping

Fees from insurers, self-funding patients and private hospitals arrive on different terms, and the gap between what was billed and what was paid is where private practice accounts usually come apart. We keep the ledger against the bank, track what is outstanding, and tell you what is actually collectable rather than what was invoiced.

Practice costs sit alongside it: secretarial support, indemnity, room hire, professional subscriptions. The test is the same one HMRC applies to any trade, which is whether the cost was incurred wholly and exclusively for the practice.

VAT on Medico-Legal and Cosmetic Work

Most clinical care is exempt from VAT, but the exemption is narrower than doctors expect. It requires both that the service falls within the profession you are registered in and that its primary purpose is protecting, maintaining or restoring the patient's health. Work whose main purpose is to let somebody else make a decision does not qualify.

That catches medico-legal reports, pre-employment and fitness medicals, and cosmetic work done for cosmetic reasons alone. A consultant with a substantial medico-legal practice can cross the £90,000 registration threshold on that income while believing all of it is exempt. We check the position before it becomes a backdated assessment.

Keeping NHS Income and Private Income Apart

The NHS contract is employment income and stays on the employment pages of your return. The private practice is trading income with its own accounts. Costs that genuinely serve both are apportioned, and the apportionment has to be one you could explain to an inspector rather than a round number chosen for convenience.

Where private income has grown enough to be worth structuring differently, that is a separate question with its own arithmetic, covered in our guide to trading as a sole trader or through a company.

Fees for Private Practice

A fixed annual fee covering the practice accounts, the return, and the VAT position where one applies. Quoted before work starts, based on billing volume and whether there is a company or a VAT registration in the mix.

We do not take a percentage of practice income and we do not charge more because the practice had a good year.