When should I leave the NHS: Reflections for psychologists and therapists thinking about taking the plunge into independent practice
Today I am not writing about strategy, it's not about a process, it's not about tips. That's because I really can't give you any when it comes to this question. Today we're talking about something really personal, we're talking about the decision that many of us grapple with, here in the UK, about when to leave the NHS. For our international readers, the NHS is the institution that provides free health care at the point of need, something that most of us are really committed to and very fully believe in, in the mental health space. However, the NHS is not an easy employer. There have been a lot of difficulties over the past decade, and probably before that, in providing the kind of mental health services that we want people to recieve. So this blog will be relevant for anybody considering leaving employment, considering reducing their hours, or who just feels a bit paralysed by that question.
I'm not going to give you a tick sheet, or a process that you can follow to help you make that choice. Of course I can't do that. But what I am going to do is share some of my personal experiences. I'll share the reasoning behind my decision to leave the NHS. And then I'm also going to share with you the wisdom of 47 other psychologists who answered this question for me, in one of our private practice groups, which is called UK Psychologists in Private Practice (UK3P), if you're not in it, you should be in it. It's a brilliant group. I asked in there how people knew it was the right time to leave the NHS because I know this is something that so many of us struggle with. So many people that are considering jumping into Psychology Business School, or joining the Do More Than Therapy Membership talk to me about this dilemma. So I thought I'd really like to create a podcast, which doesn't give you the answers, but lets you in on the reasoning of people who have made that decision so that it can maybe help you to feel a little bit more supported, a little bit less alone with that big decision that you're grappling with.
Why did I start thinking about my decision to leave the NHS and start an independent practice 4 years ago?But before we get started, I also want to share with you some more personal stuff from me, that actually prompted me to start thinking about this. So those of you who have eagle eyes, or who are involved in Psychology Business School, or the Do More Than Therapy Membership, might have noticed that my camera has been moving slowly further up, so you can see less and less of my body recently in social media videos, or in zoom trainings that I do in Psychology Business School. And the reason for that is that I am expecting my third child. I'm very pleased to announce that I'm currently 22 weeks and feeling OK. And as it's my third child, I do have quite a sizable baby bump. I never find pregnancy very easy. And that's a whole topic for another podcast that I certainly will be making, and might even be writing a book on, but I have not felt well and there's been real challenges, but I'm now feeling pretty good and I want to use this time to help other people that might be in a position of going through a big life transition and wondering what on earth that means for their career.
The story of why I left the NHS to start an independent psychology practice
My story is all about my family, and it's all about my children. My daughter had just started at nursery, I'd gone back into a locum role in an NHS team. We're a military family, so I already knew that I couldn't go back into a role within a permanent team. And that made me really sad because I had loved the role that I had in Tower Hamlets. I worked in the Learning Disability Service there, had a really challenging role, but one that I would have loved to have done for a lot longer. But unfortunately, I knew that as a military family, we were likely to be moving within 18 months. So I took a short term locum contract with a local team.
I was really keen to get back into the NHS, I'd really missed it while I'd been on maternity leave, I never really saw my career going in any other direction. I'd been incredibly grateful to get onto training as a clinical psychologist. For anyone who maybe took a different route or might be international listening to this, the NHS fund our training as clinical psychologists and we're extremely privileged in that position compared to other mental health professionals, like counselling psychologists, people who do psychotherapy courses, you know they usually have to self fund them. So I was aware of how lucky I'd been to get my doctorate paid for by the NHS. But also ideologically, I'd grown up really loving the values of a free health care, free at the point of need was something that was very important to me. And the client groups that I'd worked with, you know, specialising in learning disability, were not people that were ever going to be able to directly pay for those services. So, in a way I really hadn't ever imagined independent practice being part of my career. I'd imagined a few things maybe like research, maybe working for a charity at some point, maybe working for a university. But I'd never imagined that I would give up working in the NHS altogether. It just wasn't part of my thinking.
I enjoyed a lot of aspects of the locum role. Unfortunately, my daughter did not get on well with nursery. She just was ill all the time, every bug was destined to make her unwell for at least a week. So I really struggled to ever be at my NHS job. I was solo parenting, my husband was deployed, he's in the Navy, and I had no friends or family anywhere near me. So it was me, you know, I had to be the one who hotfooted it down to nursery every time she got a temperature, I had to be the one that took all the time off work until she was ready to go back to nursery. I was the one doing all of the sleepless nights. The buck stopped with me. So it was really difficult on lots of practical levels. Really difficult because I knew I was letting my team down. And as much as lovely friends would try and say to me, you know, I'm sure you're still doing a really good job, and they really value you, and they were lovely to me about it, I should say. My manager was so kind and so accommodating, and they helped me with every kind of flexibility that they could extend to me. But the fact was, I was just not able to do the job in the time I was able to be there. It was a big job, too big for a locum I have to say, and, you know, I would have, I would have campaigned for a lot more psychology provision in that service. But the fact was, I wasn't even able to give it what the job description required.
So for all of those reasons, trying to keep it up was really eroding my self esteem. It was making me feel like a bad person. It was certainly making me feel like I couldn't live my values. I wasn't being the psychologist I wanted to be, I wasn't being the mum that I wanted to be either, because I was frequently, you know, making those borderline decisions, you're like, well, she's still a bit poorly, but can I give us some Calpol and send her in? Not proud of that, but it happened. And I know, any of you who are solo or single parents will relate to that feeling where you're just torn in a million and one directions. To add to this context, I was pregnant at the time with my second child, with my little boy. And as I mentioned at the beginning of this podcast, pregnancy is difficult for me. It's difficult for me physically, it's difficult for me psychologically. And I started to feel quite vulnerable.
So I did a couple of things. I enrolled on a mindfulness course with Bangor University. And I really recommend that, hugely recommend that. If you are pregnant right now, or going through any life transition, and you are struggling psychologically, doing a structured mindfulness programme can be really transformative. And what it did for me was, it forced me to spend some time with my mind, it forced me to spend some time with my values, and it enabled me to see that I wasn't living them. And that, actually, there might be a different path that would allow me to do more of what felt like my calling, and while still being the parent that I wanted to be.
I'd had these blinkers on for my whole career, and I see this when I talk to people who are considering leaving the NHS all the time and when I talk to people who are considering Psychology Business School. They want to do it but it feels like it's stepping into the dark side, or giving up on something that they've been really passionate about. It starts to feel really black and white, and I very much had that viewpoint. I thought that if I stepped into private/independent practice then it's going to be all about helping wealthy people, it's going to be all about trying to make money for myself. It felt like the selfish route. Which I now think is crazy, I do not share that opinion now, but I'm just letting you in on where my head was at the time. But it also felt like it might be the only thing I could do that would allow my daughter to get more sleep. I'd kind of come to this realisation that she was a child that needed more sleep than the nursery routine could give her. Simply getting up that early in the morning, I felt was contributing to her illness. And when you have that instinct as a parent, you have to follow it. The mindfulness course allowed me to tune into it, amongst other things. So the decision actually became a pretty easy one, even though it was very painful.
With a lot of pain in my heart, and a lot of insecurity in the pit of my stomach, I made that decision, handed in my notice and left that locum job. So this left me setting up a private practice, feeling like a bad person, feeling like I didn't want any of my NHS colleagues to know that I'd gone to the dark side and was going to be doing this very dirty, filthy, awful thing. And, and also really unsure how I was going to make this private practice into something that hit my values.
I think one way in which I was possibly quite fortunate is I never lost this sense that I would make it work for me evenually. I think I've always had a bit of an entrepreneurial spirit, I've always quite liked the idea of being my own boss and I definitely have a creative edge to my personality. So although I was really anxious about how I was going to do it, I knew that I was going to do it. And that is probably why I made the decision to invest in business courses and getting coaching fairly early on even though I really didn't have any money. Going from maternity leave into a locum role where you're never there, so I didn't get paid, and paying London rates for childcare, meant there really wasn't much sitting in my bank account to help me set up my practice. Which is another reason that when I set up Psychology Business School, it was really important to me to have an installment plan, because although I've been told by a million people that that doesn't make business sense, I still feel like I need to do it because I know that I couldn't have paid the full ticket price.
I did two things when I was at this sort of crossroads and feeling really, really lost. I managed to get myself on a free programme, which was available to military spouses, called Supporting the Unsung Hero. And yes, we are unsung heroes. I love that term. But this is a course specifically offered by, I think it's Lloyds Bank, for military partners who are being kind of thrust into self employment, because we often can't hold down jobs because of the lifestyle. So that was a really positive thing that was accessible to me. But what I've discovered since then, is that actually, there's a lot of free business courses out there that are run by the banks, by other big institutions that you might be able to get support from, especially if you have a mental health mission. So check out stuff like the School for Social Entrepreneurs, they've got a startup programme, which is just super valuable and gives you lots of information about basic business setup. And also, you know, check out your bank and see if they're running anything near you. So I know NatWest run them, I believe Lloyds do too. So definitely worth checking out those opportunities, because they're not going to give you specific tailored, independent practice advice in the way that something like Psychology Business School does (plug) for example, but what they can do is give you those really basic foundations like, this is a business bank account, this is what you do with tax, those kinds of things, which are just generic to all businesses, but I had no clue about. So I got myself on one of those. And I also knew that because I move a lot, and because I didn't have much of a network in the area that we were living, I didn't have loads of professional connections around me, didn't have things in place to get referrals into a private practice, then I knew that I was going to have to get quite good at marketing quite quickly. So the other thing I invested in was an instalment plan for Janet Murray's online marketing course. These were really, really good decisions. Because being around other people who were also petrified, who also felt that they had no business knowledge, that they were in completely the wrong arena, that they didn't know what they were doing, it just showed me that that imposter syndrome is universal. And that eventually if I was determined enough, I would overcome it and that I would get more confident and I would get the business working.
So that's a little bit about my journey. It was messy, I felt like I was pushed, I didn't jump. And it was with a real mixture of sadness and pain, but also excitement about what I might be able to do for myself, how I might be able to live my values a bit better in independent practice.
But most people don’t have one event that “pushes” them in the way that I was pushed. For most people it is a much slower, and more agonising decision and I think that's what leads to a lot of this paralysis that I'm hearing from people considering coming into Psychology Business School, considering coming into independent practice, but are really struggling to kind of make those decisions. So I thought it'd be really helpful to gather some experiences from other psychologists in the UK3P group. But before we dive into that, I just want to say that my intention in this podcast is to provide you with a sense of community. If you're in a position, maybe a bit like mine, where you're wondering if continuing in your NHS role is right for you. I'm absolutely not suggesting that any one path is better than any other path. The route I've taken has really shown me that we can do incredible things within and outside of the NHS. But I do believe it's important to find a path that allows you to live your personal values. So before we go into people's experiences, and thinking about the reasons that people have left the NHS, I just want to talk a bit about the positives of NHS employment and why so many of us stay in it for so long.
Why do psychologists and therapists love working in the NHS?
- The team. When it works, and even when it isn't quite working, you do get to work alongside some very awesome individuals. So the team is a big one.
- The pension, enough said.
- Stability. You know what money is coming in at the end of every month. And while that can definitely happen in independent practice, it takes a little while to get there.
- It is technically available to everybody, because it's free at the point of need, technically, NHS services are available to everyone who needs them. Now, I think all of us with a bit of experience know that there are groups that really struggle to access NHS services. And so I felt a bit funny about owning that one, because I'm not sure it's entirely true, but that's the idea, or at least that's the ethos that the NHS is working towards, which is one that we can all get behind, I'm sure.
- Diversity of clients. Again, technically. I think most of us will have found that certain services are used more by one community than another, and there's often not as much diversity as you would expect. But you probably do get more diversity of clients than you do in your standard independent practice.
- There are potential opportunities for service development. I was involved in service development as a trainee, I was involved in service development as a qualified psychologist, and that's something I really valued and enjoyed in the NHS.
- There are potential opportunities for research. I believe.... not that I ever met anybody who had the ability to do any research in their role. I know there are people that do, and you would have the resources of the NHS to help you with that when that opportunity did arise for you, and that's something I've very much hoped for in my career. And if I ever go back into the NHS, which I might, then that's something I'd be looking for.
- There is at least perceived authority about being an NHS health professional. There's some status attached to it, either in our own minds, or sometimes in the minds of clients as well. I've definitely heard from clients that I've seen in independent practice that they're reassured by the fact that I was NHS trained. And I think I would be if I was looking for private health care of any sort, I'd want to know that they were also working in the NHS. So I think that's a bonus to it.
So knowing all of that, knowing all of those positive sides, getting in touch with those and thinking about what you do value about working in the NHS is just as important as thinking about your reasons for potentially...
