Having completed 18 months now as a fully mobile independent speech therapist working in and around Edinburgh and East Lothian, I thought I would write a brief review of my experiences so far. I also thought I’d share with you a lovely sunset I saw at Gosford Bay, Longniddry, East Lothian on my way home after a speech therapy session in Edinburgh.
The view to Edinburgh from Gosford Bay, East Lothian
The good and the bad
Updating the Blethers Facebook Page
Working totally for yourself can be really good but it is not for the faint hearted. There are so many things I have had to learn that are never mentioned in a speech therapy degree. I have had to be my own IT department, purchasing department, accountant and business advisor. I have also had to rope my husband in as my able and long -suffering speech therapy assistant. Together we have spent many happy hours cutting out therapy materials, laminating, making post boxes and thinking how to make the Blethers Speech and Language Therapy business work well. I am certainly very lucky to have such a supportive partner!
The first thing to note is that I am really enjoying working for myself and find it very emotionally rewarding. Working as a generalist with a wide range of clients in a mix of locations and meeting parents who have a really keen interest in engaging with speech therapy for their child has been really satisfying. I have also been able to work well and communicate well with NHS staff in a way that I felt was sometimes missing when I used to work in the NHS. Being able to see both sides of the fence between private and state sector is a definite advantage here – knowing some of the limitations of working within the NHS and, on the other hand, knowing some of the challenges of the independent sector too makes it much easier to work effectively together across public and private sectors.
A great place for lunch or some note writing.
Being in control of how I work means that I am have the freedom to choose when and where I eat lunch, do my admin and how much holiday I take. This aspect of independent working is really great! I also really appreciate that I no longer have to despair when an ill-considered statistics form comes my way, gathering bad data that will then be analysed and used to “improve” the way I work. I do understand the need to collect statistics but all too often, data collection is designed by a faceless part of the NHS management machine working in isolation without proper consultation with those on the front line to help shape the questions so as to provide good data. Having my own mobile therapy room and assessments is also fantastic as I know exactly what’s in the cupboards, that all the correct bits are there for the assessment or game and that no one is going to interrupt a therapy session to tell me they have also “booked” whatever room or cupboard I have been stuffed into.
The main downsides of working for yourself are that there is no guarantee of any income, you don’t get paid holiday, sick pay or have any pension rights. You also still have to reflect on your own work flow to make sure what you are doing makes sense but at least you can make sure you are only analysing good quality data! There are some definite job safety and security advantages in staying part time with the NHS while you build up an independent client base, but do remember that you will still have to ensure no conflicts of interest, keep resources for your private practice separate, buy your own assessments and make sure your private practice is appropriately registered with all the necessary bodies including HMRC. There are many different regulatory organisations that you may not initially be aware of but whom you must be registered with, such as the Information Commissioners Office. It is also a fact that you will still have to complete a self assessment tax return, even if you are only working for yourself a couple of days a week, but that’s not as bad as it sounds!
I have to be honest and say that working in schools has been a bit more hit and miss than I would have liked. The majority of schools have been very welcoming but some others have been a lot more wary, I think due to the fact that I am from the independent health sector. Hopefully this will get better in time as I get to know more schools in the Edinburgh and Lothian area. Where I have found skepticism, it usually falls away if you do eventually get access to see the child in school as the teachers and staff quickly see the specialist help that you are able to give both to the child and to them. I think that some of the initial wariness perhaps comes from a lack of understanding that independent speech & language therapists are regulated & qualified in exactly the same way as those working within the NHS. Often schools have been working with independent education staff like music teachers & sports coaches for some time but are not used to engaging with the private healthcare sector. As the economic times continue to change and more and more families start to work with independent healthcare professionals, this is certainly an issue that will need to be addressed with the support of governing bodies like The Royal College of Speech & Language Therapists and the Association of Speech & Language Therapists in Independent Practice.
So what have I learned, what have I got right and what have I got wrong?
I feel I have got the service I deliver to clients right and have certainly had a lot of positive feedback from them. I think I have been clear with my clients about what speech & language therapy sessions can and can’t achieve and hope that my website passes this message on to the wider world. The mobile therapy room has proven to be a wonderful asset and real bonus for my service delivery. Clients love to use it and it gives my service an extra degree of flexibility that I would not otherwise have. Largely, I think that i have got everything pretty much right with regards to the layout and functionality of the mobile therapy room. There have been a couple of minor tweaks as I have gone on, such as the addition of some foil blinds for really hot days and a draft excluder for the back door!
In March 2012, I set up a new website as I felt that the old one was neither meeting my needs, nor those of potential clients. This took up quite a bit of my time but I have felt it was (and still is) well worth the effort. The new website has made it easier to provide clear information to clients and has also increased the number of potential clients visiting Blethers. I feel that the main thing to continue doing via the website is to add well written and useful content with regular updates. The growth of mobile devices does mean that I will need to have another tweak of the website sometime in the not too distant future but hopefully this will be a little less painful!
Another thing I have learned is to become far more cost conscious. I have had to look really carefully at each different item I purchase and make sure it is something I need and that will benefit clients. Some items such as assessments, Boardmaker and Black Sheep Press worksheet packs are essentials in my opinion but it is amazingly easy to spend thousands very quickly! Buying a core set of simple assessments then getting each additional assessment as I needed it has worked well for me. Buying assessments in this way has meant that I have built up a good library over time without a huge and unnecessary initial outlay. That said, if a client needs a specific assessment, then you really do have to bite the bullet and buy it if you have chosen to take that client on – the £670 for the Clinical Evaluation of Language Fundamentals was a particularly painful day for me but I have used it several times since. Thankfully I have been able to make many therapy materials myself (with the help of my able assistant!) and kind friends with growing children have also been able to provide me with many toys and games along the way.
I would like to offer a word of caution at this point with regards to contract payments. Whilst they are good as they spread costs out, they can be significantly more expensive and the less regular nature of private sector income means that you need to be quite careful so you can balance your income and outgoings each month. On the topic of balancing incomings & outgoings, I’d also like to take the opportunity to say that it’s really important to make sure that you keep aside about 25% of your profit (if any!) each year until your tax bill comes in. It’s very easy to forget to do this and find yourself landed with a large tax bill that you hadn’t accounted for. I’m glad someone gave me that heads up right back at the start! Unfortunately your wages are the last thing to come out of the pot so good financial discipline is required!
One thing I feel I did not get quite right at the beginning was my fee structure. I have chosen to go with the mobile approach to speech therapy rather than working from a fixed clinic as I felt this offered more flexibility for clients, parents and schools. The main drawback of a fully mobile service is that it does make sessions more expensive as it significantly limits the number of sessions you can offer per day – I found 4-5 is a comfortable maximum, depending on how spread out my clients are geographically. With this limitation in mind plus the fact that many children reach their absolute maximum attention capacity by 30-45 minutes, you can find your income severely limited unless you think carefully about your pricing. That said, it is important to make sure that you are always offering sessions appropriate to your clients needs, developmental levels and attention span and in my opinion it is better to be clear with graded costs and pricing than to insist on a minimum session length. On the one hand a clinic-based service is definitely more efficient in terms of the therapist’s time and can make it easier to accommodate lower session fees without becoming unsustainable. On the other hand, the downside is that you do need a bigger client base to support bigger overheads and, although the therapist’s day is more efficient, it can be more awkward for parents as they have to travel to reach the clinic.
Ultimately, how do I rate independent working?
Overall, I have to say that I’m glad I took the plunge and set up Blethers. Whilst I’ll never be a millionaire, I find it incredibly emotionally rewarding working in this way and the feedback I’ve had from my clients lets me know that my service is working well for them. As I continue to streamline my basic service, the question in my mind now is, where to next? How can I take this forward more and provide and even better service? Always reflect on yourself and try to see where you can make things better!