NHS vs Private Practice: Which Path is Right for You as a Clinical Exercise Physiologist?
NHS vs Private Practice: Which Path is Right for You as a Clinical Exercise Physiologist?
For newly registered Clinical Exercise Physiologists, it can be difficult to know which direction you should head in. The NHS offers structure, security, and clinical depth. Private practice offers autonomy, earning potential, and the freedom to build something of your own. And increasingly, a growing number of CEPs are doing both.
There is no universally right answer. It depends where you are in your career, what you value, and what kind of working life you want to build. This article sets out the honest case for each path, including the financial realities, the trade-offs, and the option most CEPs don't talk about enough: the hybrid model.
Disclosure: As the author I work in private practice and have not worked in the NHS. The NHS section draws on publicly available information, NHS Employers data, and conversations with NHS-based practitioners. I have aimed to represent both paths fairly.
The NHS Path
The Financial Reality
Your AHCS registration matters here more than anywhere else. Without it, you are likely to enter at Band 4 or below. With it, you are eligible to apply for Band 5 and Band 6 roles from the outset — a meaningful difference in both salary and professional status.
For 2026/27 in England, Band 5 runs from £32,073 to £39,043 and Band 6 from £39,959 to £48,117. If you are London-based, Inner London weighting brings Band 5 up to £38,488–£46,852 — a significant uplift that makes NHS work considerably more competitive in the capital than elsewhere in the country.
Beyond the headline salary, the NHS benefits package is valuable and often underestimated by those considering private practice: a defined benefit pension, 27 days annual leave rising to 33 with service, sick pay, and maternity and paternity pay. For practitioners early in their career or with financial commitments, this security is worth a great deal.
The Clinical Reality
The NHS offers something private practice cannot easily replicate — clinical depth. Working within MDT environments alongside physiotherapists, consultants, nurses, and other allied health professionals accelerates your development as a clinician. You will see complex, high-acuity patients and work within established clinical protocols. It is worth noting that NHS CEP roles are typically tied to specific services — cardiac rehab, pulmonary rehab, or cancer prehabilitation. This means your clinical exposure will be deep within that speciality, which is genuinely valuable, but if you are someone who wants broad experience across multiple conditions early in your career, it is worth thinking carefully about which service you join — or whether moving between services over time might suit you.
The Trade-offs
The NHS comes with real constraints. Salary progression is structured and slow — movement between bands requires the right role to become available, not just strong performance. Bureaucracy can be significant. Geographic flexibility is limited by where NHS trusts are hiring. And for practitioners with entrepreneurial instincts, the lack of autonomy over caseload, speciality mix, and working patterns can feel frustrating over time.
The Private Practice Path
The Financial Reality
Private practice has a much higher ceiling — but also a much more uncertain floor, particularly in the early stages.
Session rates in the UK for CEPs currently range from approximately £80 to £150 per session, depending on location, speciality, and experience. London practitioners tend to sit at the higher end of that range. Initial assessments typically command a premium above follow-up sessions given the time and clinical complexity involved.
The maths can look compelling on paper. Ten private sessions per week at £120 is £1,200 — £62,400 annualised before expenses. But building to ten sessions per week takes time, and in the early months your income will be considerably lower than that. Expenses — professional indemnity insurance, platform or booking fees, CPD, equipment — need to be factored in.
The key variable is how quickly you can build a patient base, which depends heavily on your referral network, your online presence, and your niche.
The Clinical Reality
Private practice gives you complete control over your caseload. You choose your speciality, your patient population, and your working hours. Many CEPs find that working privately allows them to deliver more personalised, longer-term care than the session limits common in NHS pathways allow.
The trade-off is that you will see a narrower range of clinical presentations, particularly early on. Your caseload will be shaped by who finds you and who can afford to pay, which may not represent the full breadth of conditions you trained to treat.
The Practical Reality
Running a private practice means running a business. Invoicing, scheduling, marketing, tax returns, and patient acquisition sit alongside the clinical work. Some practitioners find this energising. Others find it a drain on time and mental energy. It is worth being honest with yourself about which camp you fall into before committing fully to private practice.
Our platform, The Health Nav, is designed to reduce this burden — handling discoverability, booking, and professional verification so that practitioners can focus on clinical work rather than administration. But even with platform support, building a private caseload requires consistent effort, particularly in the first year.
The Hybrid Model
The option that doesn't get discussed enough is doing both — and for many CEPs, particularly those earlier in their career, it is the most sensible path.
Working part-time in the NHS while building a private caseload gives you the security of a guaranteed income while you grow something of your own. The NHS role keeps your clinical skills sharp and broad. The private work builds your autonomy, your earning potential, and your professional identity beyond a single employer.
Many of the most established CEPs in the UK have built their careers this way — using NHS employment as a foundation and private practice as the growth engine. It requires energy and organisation to manage both, but the risk is considerably lower than going fully private from the outset.
Which Path Suits Which Person?
Rather than prescribing an answer, here are some honest questions worth sitting with:
- How important is financial security to you right now? If the answer is very, the NHS is the safer starting point.
- Do you have an existing patient referral network or professional reputation to draw on? If not, building a private caseload will take longer than you expect.
- Are you motivated by clinical complexity and breadth, or by autonomy and entrepreneurship? The NHS offers the former; private practice the latter.
- Are you prepared to manage the business side of private practice, or does the idea of it feel like a distraction from clinical work?
There is no wrong answer to any of these questions. But being clear-eyed about them will save you from making a career decision based on the financial upside of private practice while underestimating what it takes to get there.
Salary Comparison: NHS vs Private Practice (2026/27)
The table below illustrates the financial reality of each path — but the non-financial factors are equally important when making this decision.
| NHS Band 5 | NHS Band 6 | NHS Band 7 | Private Practice | |
|---|---|---|---|---|
| England (entry) | £32,073 | £39,959 | £49,387 | Variable |
| England (top of band) | £39,043 | £48,117 | £56,515 | Variable |
| Inner London (entry) | £38,488 | £47,951 | £58,133 | Variable |
| Inner London (top) | £46,852 | £56,863 | £65,261 | Variable |
| Typical session rate | — | — | — | £80–£150 |
| 5 sessions/week (annualised) | — | — | — | ~£20,800–£39,000 |
| 10 sessions/week (annualised) | — | — | — | ~£41,600–£78,000 |
| Pension | Defined benefit | Defined benefit | Defined benefit | Self-arranged |
| Sick pay | Yes | Yes | Yes | No |
| Annual leave | 27–33 days | 27–33 days | 27–33 days | Self-arranged |
NB: Private practice figures are gross, before expenses including insurance, CPD, and platform fees, and assume a full caseload which typically takes 6–12 months to build.
A Final Note
Neither path is permanent. Many CEPs start in the NHS, build their clinical foundations, and transition into private practice or a hybrid model as their career develops. Others go private early and return to NHS roles for specific opportunities or lifestyle reasons. The profession is young enough in the UK that there are no fixed rules yet — which is both the challenge and the opportunity.
If you are considering building a private practice alongside or instead of NHS work, The Health Nav is designed to support exactly that — giving registered CEPs a professional platform to reach patients, build their profile, and manage bookings without the administrative overhead of starting from scratch.