you ever thought of setting up on your own as an occupational health
consultant? While this style of working will not suit everyone, the benefits of
being your own boss can be yours through determination and by adopting a
professional approach, by Cynthia
Running my own consultancy was something I had always wanted to do. However,
due to personal circumstances it was not possible until I resigned as Head of
OH Nursing with BUPA Occupational Health in July 1999.
At that time I did not know what my next move would be. I took three months
out to take stock of my life, decide what I wanted to do and, most importantly,
spend time with my family and friends. Travelling to London from Staffordshire
every day for seven years had not left much time for anything other than work.
This article, based on personal experience, provides information and
presents ideas for those who aspire to work as an independent consultant.
According to the DfEE’s Labour Market Trends for 19971, 99 per cent of UK
businesses are small and medium-sized enterprises – SMEs, employing fewer than
50 people, with nine out of 10 firms employing fewer than five people. The
HSC’s Occupational Health Advisory Committee’s 1999 report2 also discusses the
changing patterns of employment and the effects this has on the provision of
occupational health to the working population.
Reports such as these have had a significant impact on the number of private
occupational health services and independent occupational health consultants.
The trend towards smaller businesses, short-term and part-time contracts, and
homeworking, has made the provision of occupational health services more
difficult. Therefore, to increase the opportunities for people to have better
access to services, there has been a massive growth in freelance consultants.
Opportunities for occupational health consultants have never been greater,
as companies look for more flexible and accessible services. However, working
independently does have its problems and challenges. The main challenges are:
– Deciding on what services you can provide, how and to whom
– Setting up the business – should you be self-employed or form a limited
– Deciding on pricing – how much to charge
– Obtaining work – promoting yourself, what services should you offer, how
should you advertise?
– Obtaining the skills to manage your own business, such as basic
accounting, dealing with tax and VAT, understanding data protection issues
– Deciding what office equipment will you need, including computer hardware
and software systems and their costs
– The practical aspects – managing letter and report writing, invoicing,
setting up and managing records and filing systems
– Developing links for access to other advice and support, such as
occupational medicine, hygiene and safety. It is also vital to monitor your
standards – auditing and peer review must be included
To address some of these challenges I made contact with the Training and
Enterprise Council in my local area. The TEC provides information, support and
training for setting up in business. Most of its services are free and it
provides ongoing support for up to a year which I found invaluable. I did a
five-day course, which covered the basics of setting up in business, including:
– Calculating a survival budget
– Assessing the market and forecasting the first year’s sales
– Tax, VAT, insurance, record keeping and accounting
– Cashflow planning
A business plan
At the end of the five days attendees were expected to produce a business
plan for our proposed ventures. While business planning is something I had been
involved with in many of my previous jobs, doing it for yourself is very
The business plan is a fundamental document for any business. It helps to
crystallise and focus ideas, set objectives and to monitor performance. It is a
vital tool when dealing with the bank if you need to secure financial backing
or overdraft facilities.
Whether you decide to be self-employed as a sole trader or trade as a
limited company must be your own decision and depends on what you are planning
This also applies to whether or not you register for VAT, which is
controlled by turnover. The present limit for VAT is up to £51,000 turnover a
year, after which it is a legal requirement to register. I decided to register
as a matter of course, having obtained advice from the local enterprise
council. This has advantages when buying supplies, and most of the companies I
deal with expect their suppliers to be VAT registered.
I set up as a sole trader as I did not intend to develop the business to the
point where I had to start employing others. However, had I been starting
earlier in my career, I would probably have set up as a limited company.
Calculating tax and national insurance contributions was another aspect of
business covered on the course. Although an accountant will do this for you it
is always wise to know how it is done so that you can check and feel in
Having good office equipment is important – a computer is essential,
together with the right software to help manage the business.
There are a number of good software packages available, which will produce
invoices, automatically transfer the details to your business money account and
ultimately produce information for the VAT return and financial year-end
information, at the press of a button.
My original business plan objectives and services I intended to provide have
changed greatly over the past three years. Although I did carry out some
advertising and circulated information leaflets to various organisations, most
of the work I have obtained has been by word of mouth. Therefore I would not
advise anyone to spend a lot on advertising. It is also important to target
advertising to specific businesses.
One of the issues I was concerned about was working alone as apart from my
first post in occupational health, I had always worked in a team and latterly
had been leading interdisciplinary teams. However, to overcome this I have
maintained contact with many of my medical, hygiene and nursing colleagues –
something that is vital in accessing support and advice when needed.
Setting professional standards
The need to have written professional standards is paramount to practice
anywhere and even more so as an independent practitioner. Customers need to know
what you can provide, how you will provide it and what the professional
When negotiating for work a contract of prices and service levels is
normally agreed, but just as important is the need to draw up an agreement on
the professional standards that will apply. As a minimum these standards should
include reference to the Nursing and Midwifery Council Code of Professional
Conduct; confidentiality; data protection and access to medical records;
medical reports; and sickness absence management.
This approach will mean there should be no surprises and will stop customers
making requests that could be unethical or breach confidentiality. However,
this cannot be guaranteed.
Insurance and professional indemnity
No OH nurse should be working without professional indemnity insurance. When
OH nurses are employed, employers have vicarious liability for their actions,
however self-employment is a different matter, so cover is vital.
You should consider the need for public liability insurance and seek advice
from your insurers. There are differing views on the need for consultants to
have public liability insurance and much will depend on the type of work you
intend to carry out and the possibility of harm to the person or damage to
property, when carrying out those services.
Working independently means that you could be working with many different
organisations, both in the public and private sector. SMEs are the main targets
as most of the large multinational companies either have an in-house service or
are serviced by the larger, private occupational health providers.
However, there are also opportunities available in some large companies,
which are looking for local provision and do not want to deal with the major
providers. These companies will usually have their own general policies and
procedures, controlled at head office, but want local needs to be the priority
and there is room for innovation here.
This variety means that you have to adapt on a daily basis to changing
cultures. Some of the businesses I deal with have a very casual approach to
business and they expect me to be the same, and this can be a challenge if you
are more used to a formal approach.
The advantages of working as a freelance consultant far outweigh the
Some people see being a consultant as the last resort, when you cannot do
anything else. It is quite the opposite. You must be a self-starter, set high professional
standards and work to them, be self-disciplined; have good procedures; a
positive manner and the ability to deal with all types of customers.
You can do it by adopting the right positive attitude towards hard work, an
acceptance that things will not always go the way you have planned and the
right personality to cope with disappointments.
My only regret is that I did not work for myself earlier in my career,
although on reflection the time might not have been right before.
I would now find it very difficult to be an employee. I would hate losing
the degree of control I now have and the thought of, once again, being placed
under pressure and stress by someone else is unthinkable.
The main secret of success is to set yourself up in a professional way and
make sure you have good computer systems. Ensure you have a good support
network of professional colleagues – without this there would have been times
when I would have given up. After that all you need is the sheer determination
1.DfEE (1998) Labour market trends for 1997 and the DTI Statistical Press
HSC (1999) OHAC Report and Recommendations on improving access to
occupational health support, Good health is good business and Our healthier
nation. London: HSC.
– The Enterprise Agency/ Business Advice Service – contact your local branch
– Business Link tel: 0345 202122.
– The Enterprise Zone (backed by UK Government) www.enterprisezone.org.uk
– Federation of Small Businesses website www.fsb.org.uk
It would be good to hear how other freelance consultants have managed.
Perhaps we can start a discussion through Occupational Health, e-mail the
editor on: email@example.com or write to: Occupational Health, 3rd Floor,
Quadrant House, The Quadrant, Sutton, Surrey SM2 5AS
Cynthia Atwell is an independent occupational health consultant
Benefits to the client
– Independent advice – no hidden agenda, able to focus on customers’ needs
– No pressure from a bigger organisation to sell other
services, that are not necessarily needed
– Development of specific services to meet the needs of the
– Easier access, direct contact with the service provider
without having to go through others
– Personal service with direct access to the consultant
– Can be more cost-effective – fewer overheads
– Flexibility of service. Many companies want to call for
advice and/or request a visit at varying times, they do not always want routine
visits. This can usually be easier to manage with an independent consultant
Pros and cons of working freelance
– Providing the services you want to provide and the freedom to
– Working the hours and days you want to work – although this
can also be a disadvantage as the paperwork can mean working at weekends to
keep things under control
– Setting and controlling your own professional standards
– More opportunity to develop good relationships with customers
– Having control of your own workload
– Being able to be more innovative in service delivery
– Being able to be more ‘accountable’, making your own decisions
– Working in isolation, without the immediate support of the
wider organisation and team
– Keeping up with paperwork, particularly invoicing and VAT