Private practice physiotherapy has a payment quirk few other professions deal with: insurer-billed sessions can take weeks to actually land in your account, well after you treated the patient. That timing matters more than you'd think for MTD, alongside the ever-present question of whether a clinic's split-fee model makes you self-employed at all.
Insurer-funded treatment, through BUPA, Vitality, AXA or similar, often comes with slower, more bureaucratic payment terms than a private self-pay patient settling on the day. Under the cash basis, the default for most sole traders, income counts when you actually receive it, not when you delivered the session.
Many physios work on a split-fee basis, paying a clinic a percentage of what they earn in exchange for a treatment room, admin support, and a referral stream. Whether that's genuine self-employment depends on control: if you manage your own caseload and treatment approach, it usually is. If the clinic sets your hours, assigns your patients, and directs how you treat them, HMRC may view it differently.
Physio income from different clinics, insurer panels, and private self-pay patients is normally all the same self-employment business if you're self-employed throughout, so it's combined into one gross income figure against the MTD threshold, regardless of how differently each stream pays or how quickly.
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Under the cash basis, income counts when you actually receive it, not when you treated the patient. If BUPA or another insurer pays eight weeks after a session, that income falls into whichever quarter the payment actually lands in, not the quarter you delivered treatment.
It depends on the arrangement. If you manage your own caseload, set your own approach to treatment, and simply pay the clinic a percentage or room fee, that's usually genuine self-employment. If the clinic sets your hours, provides your patients, and directs your treatment closely, HMRC may view it differently.
Yes, if you're self-employed at each one. Physiotherapy income from different clinics, insurer panels like BUPA or Vitality, and private self-pay patients is normally all the same self-employment business, combined together against the MTD threshold.
Yes. Your Health and Care Professions Council registration, Chartered Society of Physiotherapy membership, professional indemnity insurance, and relevant CPD courses are normally allowable business expenses against your self-employed income.
Your NHS salary is PAYE income and never counts towards the MTD threshold. Only your separate self-employed private practice income is assessed, once it exceeds £1,000 a year for registration, and the relevant MTD threshold for full quarterly reporting.