MTA
Medical Tax Accountants
Specialist accountants for private clinics

Healthcare businesses,
built on solid numbers.

Private GP services, aesthetic clinics, physio and therapy centres, diagnostics and healthcare startups — structure, healthcare VAT, payroll and the reporting a growing clinic actually needs.

Book a free consultation See what we cover
The clinic finance problem

A clinic is a healthcare provider and a business — and the rules for each collide.

VAT that depends on the purpose of each treatment, clinicians whose engagement status HMRC actively tests, regulation that dictates when you can even open — clinic finances have traps a generic small-business accountant never meets.

The healthcare VAT line

Medical care is generally VAT-exempt; primarily cosmetic services are standard-rated — and HMRC has been actively challenging clinics on where that line sits. Classify a service wrongly and the errors compound every quarter.

How clinicians are engaged

Employed, self-employed, or renting a room — the engagement model drives PAYE, pension duties and risk. Get it wrong and the liability lands on the clinic, not the clinician.

Growth without visibility

Clinics rarely fail for lack of patients — they fail on cash flow, underpriced services and staffing costs discovered too late. Annual accounts arrive far too slowly to catch any of it.

How we help clinics

Everything a healthcare business actually needs, in one place.

From a clinician opening their first private clinic to an established multi-site healthcare business — we work exclusively with the medical sector, so the healthcare-specific rules are home ground.

Structure & setup

Company formation, shareholdings between founders, and the engagement model for clinicians — set up correctly from day one, sequenced around your CQC registration timeline.

Healthcare VAT advice

Every service line classified against the medical-care exemption — so registration decisions, pricing and VAT recovery all rest on a defensible position rather than a guess.

Bookkeeping & accounts

Cloud bookkeeping on Xero or QuickBooks, annual company accounts and corporation tax — clean books that keep lenders, HMRC and future investors happy.

Payroll & engagement

Payroll for clinical and support staff, auto-enrolment handled, and the employed-vs-self-employed question answered properly for every practitioner in the building.

Management reporting

Monthly or quarterly figures built for a clinic — revenue by service line, clinician utilisation, staff costs and cash runway — so problems surface while they're still cheap to fix.

Funding & growth

Forecasts and business plans for lenders, support through finance applications, and modelling for a second site or a new service line — grounded in how clinics actually earn.

The big decision

Practising in someone's clinic — or opening your own?

For clinicians weighing up whether to launch, here's the honest side-by-side. The right answer depends on your finances, your appetite for running a business, and the market you'd be opening into.

Working in a clinic
Owning the clinic
How you earn
Your sessions, your fees — employed salary or self-employed sessional income.
The business profit — every clinician's work contributes, less every cost of running the building.
Upside
Capped by your own hands and hours.
Scales beyond you — and the clinic itself becomes a sellable asset over time.
Risk
Low. No lease, no staff, no borrowing.
Real. Premises lease, staff costs, equipment finance and regulatory responsibility all sit with you.
Setup burden
Minimal — indemnity and registration.
Company, CQC registration where required, VAT position, insurance, payroll — months of groundwork before the first patient.
Cash flow
Earn as you work.
Costs arrive before revenue — the first year is a cash-flow exercise, and underfunding it is the classic failure.
Best for
Clinicians who want clinical work without business ownership, or who are building capital and a patient base first.
Clinicians with a clear market, funding for the first year, and the appetite to run a business alongside practising.
The honest answer: owning a clinic can build serious value, but it's a business decision, not a clinical one — and the numbers should be tested before the lease is signed, not after. If you're weighing up a launch, we'll model the first two years with you honestly, including the version where it doesn't work.
Healthcare VAT

The exemption that makes or breaks clinic pricing.

Healthcare has its own VAT world. Medical care provided by registered health professionals — services whose principal purpose is protecting, maintaining or restoring health — is generally exempt from VAT. Services whose purpose is primarily cosmetic are usually standard-rated.

The line between the two is exactly where HMRC has been focusing — aesthetic and wellness clinics have faced sustained challenge on treatments claimed as medical. And the consequences run both ways: exempt income means no VAT to charge but also restricted VAT recovery on your costs, while a mixed clinic ends up in partial exemption territory, one of the fiddliest corners of VAT.

What we do:

  • Classify every service line against the medical-care exemption, with the reasoning documented — so your position survives an HMRC enquiry rather than folding at the first letter.
  • Advise on registration — whether your taxable income requires it, and whether voluntary registration would actually help or hurt.
  • Handle partial exemption where the clinic runs both exempt and taxable services, maximising legitimate VAT recovery on costs.
  • Price with VAT in mind — so standard-rated services are priced knowing a fifth goes to HMRC, not discovered at the first return.

If your clinic's VAT treatment has never been formally reviewed — especially if you offer anything on the cosmetic side — that review should happen before HMRC prompts it.

Launch & growth

The bits that catch clinic owners out.

Launching a clinic properly

The sequence matters: structure first (company, shareholdings, clinician engagement model), then registrations (CQC where required, VAT position, PAYE scheme), then the finance plumbing (bank account, bookkeeping, card payments, pricing) — all timed around when you can lawfully open.

The classic startup mistakes are underfunding the first year, pricing without the VAT position settled, and engaging clinicians on arrangements that don't survive an HMRC status check.

Many clinic founders are consultants building on an established private practice — if that's you, our consultant accountants page covers the personal side of the picture.

Running on real numbers

Once open, the difference between clinics that grow and clinics that struggle is rarely clinical — it's financial visibility. The numbers worth watching monthly:

  • Revenue by service line — what's actually earning, not what's busiest
  • Clinician utilisation — paid-for hours against available hours
  • Staff costs as a share of revenue — the ratio that quietly kills clinics
  • Cash runway — months of costs covered at current burn
  • Debtor days — how fast insurers and self-pay patients actually pay

We build this reporting into the bookkeeping, so it arrives monthly without anyone compiling spreadsheets by hand.

Frequently asked

Questions clinic owners ask us.

Is my clinic's income exempt from VAT?
It depends on what each service is for. Medical care provided by registered health professionals — services whose principal purpose is protecting, maintaining or restoring health — is generally VAT-exempt. Services with a primarily cosmetic purpose are usually standard-rated, and HMRC has been actively challenging aesthetic clinics on exactly this line. Most clinics run a mix, so each service line needs classifying properly — it changes whether you must register, what you charge, and what VAT you can recover.
What structure should a private clinic use?
Most clinics operate as limited companies — for liability protection, credibility with insurers and landlords, and tax flexibility as profits grow. The detail matters though: shareholdings between founders, how clinicians are engaged (employed vs self-employed), and how the company interacts with any NHS pension position of the founders. We set the structure up properly at the start, which is far cheaper than restructuring later.
Do I need CQC registration before trading?
Many clinical services require CQC registration before they can lawfully be provided, and the application takes months — so the financial setup (company, bank account, bookkeeping, payroll) needs sequencing around it. We're not CQC consultants, but we work alongside the registration timeline so the finance side is ready the day you can open, not scrambling after.
How should clinicians working in the clinic be engaged?
It depends on the working pattern. Regular, rota'd clinicians under the clinic's control generally point to employment; genuinely independent practitioners renting facilities or providing sessional services can be self-employed — but HMRC looks at the reality, not the label. Getting this wrong creates PAYE liabilities for the clinic. We review the engagement model and set up payroll or self-employment arrangements accordingly.
What financial reporting does a growing clinic need?
Beyond the statutory accounts: monthly or quarterly management figures showing revenue by service line, clinician utilisation, staff costs and cash runway. Growing clinics fail on cash flow far more often than on demand — the reporting exists to see problems while they're still cheap to fix. We build the reporting around what your clinic actually needs at its stage.
Can you help with funding or expansion?
Yes — business plans and forecasts for lenders, support through finance applications, and modelling for a second site or new service line. Because we work exclusively with healthcare, the forecasts are grounded in how clinics actually generate revenue rather than generic templates.
How much do private clinic accountants cost?
Fees depend on the size of the clinic and what's included — from company accounts and tax for a small startup, to full bookkeeping, VAT, payroll and management reporting for an established clinic. We quote a fixed monthly fee after the free consultation, so the cost is known upfront.
Can I switch to you if the clinic already has an accountant?
Yes — switching is straightforward. We handle the professional clearance letter and records transfer from your existing accountant, and pick up VAT and payroll without a gap. Most switches complete within a few weeks.
Ready when you are

Two ways to get started.

Whether you'd rather pick a time and chat, or write to us first — we're set up for both.

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