How to Start an Occupational Therapy Practice in the UK

Private occupational therapy is a growing field, with demand from individuals, families, care homes, schools, employers, and legal firms seeking expert assessments. If you are HCPC-registered and experienced, private practice offers professional autonomy and strong earning potential.

HCPC Registration

Occupational therapist is a protected title. You must be registered with the HCPC (Health and Care Professions Council). Annual registration is around £106. You must hold an HCPC-approved qualification and complete CPD requirements.

Professional Memberships

• RCOT (Royal College of Occupational Therapists) — the professional body. Membership provides CPD resources, insurance options, and professional recognition.
• COTSS specialist sections — for specific practice areas

Sole Trader or Limited Company?

Most private OTs start as sole traders. A limited company becomes relevant at higher income levels or if you build a practice with multiple therapists.

Registering with HMRC

Register for Self Assessment within three months. VAT: occupational therapy provided by an HCPC-registered practitioner is exempt from VAT as a healthcare profession.

Insurance

• Professional indemnity — essential. Many insurers offer OT-specific policies. RCOT membership includes an insurance option.
• Public liability — for clinic and domiciliary visits
• Employers' liability — if you hire staff or assistants
• Car insurance — business use if you travel to client homes

Expect £300–£800 per year for comprehensive cover.

Claimable Expenses

• HCPC registration fees
• RCOT membership
• Assessment tools and equipment — standardised assessments, adaptive equipment for demonstration
• Clinical supplies — therapy materials, splinting supplies
• Clinic room hire
• Home office costs
• Travel — to client homes, schools, care homes, at 45p per mile (OTs travel extensively)
• CPD and training — courses, conferences, supervision
• Software — clinical record systems, report-writing tools
• DBS check costs
• Marketing — website, professional directories
• Phone and broadband
• Insurance premiums
• Reference materials — textbooks, journals
• Accountancy fees

Accounted tracks your expenses and keeps everything organised for tax time.

Pricing

• Initial assessment (home/school visit) — £200–£500
• Follow-up sessions — £80–£150
• Specialist reports (medico-legal, court) — £500–£2,000+
• Workplace assessments — £250–£500
• Training and consultancy — £300–£600 per day

Medico-legal work commands premium rates but involves significant report-writing time.

Building Your Practice

• GP and consultant referrals
• Solicitor referrals — for medico-legal assessments
• Schools and local authorities — paediatric OT assessments
• Care homes — equipment assessments and training
• Employer referrals — workplace ergonomic assessments
• Professional directories — RCOT find a therapist, private healthcare directories

Bookkeeping Tips

• Separate business and personal finances
• Track mileage carefully — domiciliary visits generate significant travel claims
• Record assessment tool purchases
• Invoice promptly — particularly for medico-legal work where payment can be slow
• Set aside 25–30% of profits for tax

Accounted connects to your bank and uses AI to categorise transactions.

Key Deadlines

• 31 January — Self Assessment and payment
• 31 July — second payment on account
• Every 2 years — HCPC renewal

Getting Started

Private occupational therapy is rewarding and in strong demand. Ensure your HCPC registration is current, arrange proper insurance, and keep your finances well-managed.

Ready to organise your OT practice finances? Sign up for Accounted and let Penny handle the bookkeeping while you focus on your clients.