Most consultants working in UK private hospitals also hold NHS posts — 'dual practice' is the norm, not the exception. Going private usually means seeing the same specialist sooner, with longer appointments and continuity from consultation to surgery. Private timelines are typically a consultation within days and routine surgery in 2–6 weeks, against a 12.4-week NHS median.
- ✓Most private consultants also hold NHS posts — dual practice is the norm.
- ✓Privately you buy time and continuity with the same specialist, not a better one.
- ✓The ethics debate is real on both sides — incentives versus retention and capacity.
How dual practice works
When you're referred privately to a consultant orthopaedic surgeon in most UK cities, the person you meet almost certainly spends most of their week in an NHS hospital. NHS consultant contracts generally permit private work alongside NHS commitments, and the typical pattern is an NHS job as the core of the week with private clinics and theatre lists fitted around it — an evening clinic here, a Saturday list there, sessions at a local private hospital.
This is why private hospitals can offer specialist care without employing many specialists: they sell facilities, and consultants practise there under practising privileges. It's also why the reassuring question 'is a private surgeon as good as an NHS one?' mostly dissolves — they are, overwhelmingly, the same people.
What actually changes when you see them privately
If it's the same person, what are you paying for? Mostly time, speed and continuity:
| NHS route (typical) | Private route (typical) | |
|---|---|---|
| First appointment | Weeks to months after referral | Within days |
| Appointment length | Often brief, clinic under pressure | Usually longer, less hurried |
| Who you see | The consultant's team — possibly a registrar | The named consultant, usually at every step |
| Continuity | Different faces at different stages | Same consultant from consultation to surgery to follow-up |
| Routine surgery | Median wait 12.4 weeks, often longer for surgery | Typically 2–6 weeks (indicative) |
The continuity point is underrated. On an NHS pathway you may see a registrar in clinic and meet your surgeon on the day; privately, the consultant you chose typically does your consultation, your operation and your follow-up. For complex or anxious decisions, that continuity — and the time to talk — is much of the product.
Want the same consultant, sooner?
The ethics debate, handled fairly
Dual practice has critics and defenders, and both make serious points. The concerns: private work could draw consultant time away from NHS lists exactly when waits are long; there's an uncomfortable incentive structure when the person who controls an NHS waiting list can also be paid privately to shorten the wait for individuals; and access to the fast lane depends on money.
The defences: private practice is contractually managed, with NHS commitments meant to come first; consultant pay that includes private earnings arguably helps the NHS retain senior specialists it might otherwise lose; and private work often happens in evenings and weekends — hours that wouldn't otherwise become NHS operating time. Private and NHS-funded activity in independent hospitals also adds total system throughput, as we cover in our piece on private capacity and the backlog.
What this means for you as a patient
- Don't buy the 'better doctors' myth. Choose private care for time, speed and continuity — not in the belief that a different, superior consultant pool exists.
- Use the overlap to your advantage. If you've been referred to an NHS consultant with a long wait, you can often see the same person privately for an initial consultation — sometimes then rejoining the NHS pathway better informed.
- Check who your insurer covers. Insurers hold lists of recognised consultants and fee arrangements; confirm your chosen consultant is covered before booking. Our guide to making a claim explains the sequence.
- Ask about the whole pathway. One question worth asking any private consultant: who will I actually see at each stage, and where would I go if something went wrong after surgery?
Dual practice is neither scandal nor secret — it's how UK specialist medicine is structured. Understanding it makes you a sharper buyer of private care, and a better-informed NHS patient too.
Frequently asked questions
Do NHS consultants really work in private hospitals too?
Yes — dual practice is the norm. Most consultants at UK private hospitals hold NHS posts and fit private clinics and theatre lists around their NHS week, practising at private hospitals under practising privileges. The UK effectively has one consultant workforce working across both systems.
Is a private consultant better than an NHS one?
Generally they're the same people, so 'better' is the wrong frame. What private care changes is access: an appointment within days rather than weeks, longer consultations, and the named consultant handling your care from consultation through surgery to follow-up, rather than a rotating team.
Can I see my NHS consultant privately to skip the wait?
Often, yes — if the consultant you've been referred to also practises privately, you can book a private consultation with them, typically within days. Some people do this for the initial assessment and then continue on the NHS pathway. Check your insurer recognises the consultant first if you plan to claim.
Is consultant dual practice ethical?
It's genuinely debated. Critics point to time drawn from NHS lists and an awkward incentive when the same doctor manages the queue and profits from bypassing it. Defenders note NHS commitments are contractually protected, private earnings help retain senior specialists, and private lists often use evenings and weekends. Both sides have a case.
Are consultants allowed to recommend their own private practice to NHS patients?
No — professional and NHS rules prohibit consultants from using NHS appointments to solicit private patients, and your NHS care must not be affected by declining private treatment. If you feel steered toward paying, you're entitled to challenge it and to seek a second opinion.