Private equity is consolidating UK healthcare. Independent practices can still win on cost.

Why we exist

Consolidation is not only a pricing story — it changes care. Recent reporting has described optometrists at large corporate chains under pressure to hit sales targets, rush eye exams and turn away clinical appointments, with pay cuts said to be threatened for those who put patients first (Sydney Morning Herald, via the Health Services Union). It is optometry, and it is Australia — but the dynamic travels: when a practice answers to a private-equity owner, someone, somewhere, is under pressure to make the numbers, and the numbers and the patient do not always point the same way.

Nor is it only employees. In aesthetics, franchisees of the private-equity-owned chain Laser Clinics Australia (backed by KKR) lodged a dispute reportedly seeking around A$80 million — alleging they were marked up on the equipment and supplies they were required to buy, while being pushed into aggressive discounting (SmartCompany; The Age). Employed by the group or franchised under it, the pressure is the same — and the money often leaks through the cost of the kit and consumables you are told to buy.

An owner-run practice answers to its patients, not a sales KPI — and that is better for care. We exist to keep independence viable, so the choice to stay independent is never taken away by cost alone. The rest of this page is how.

Every April costs more than the last

Ask any owner what has changed in the last few years and you get the same answer: nothing about the clinical work, everything about the bill. The cost of employing the team is set nationally and moves in one direction. From 1 April 2026 the National Living Wage is £12.71 an hour for staff aged 21 and over — a 50p rise on the year. Employer National Insurance sits at 15% on earnings above £5,000 per employee, so the threshold bites from almost the first pound of a part-time nurse’s pay.

Then comes everything else, and it all renews on its own quiet schedule: the energy contract, the building insurance, the indemnity premium, clinical waste collection, the practice-management software that went from a licence to a subscription, the card-processing rate nobody has looked at since the terminal was installed, business rates, the rent review. None of it is a crisis on its own. A 4% rise on eight lines at once is a different practice.

Costs rise on a timetable. Your prices do not. That gap is the whole squeeze, and it compounds every year you leave it alone.

The job nobody sees on the appointment book

A corporate group has a finance director, a procurement manager, an HR function, a compliance lead and a marketing team. An independent practice has an owner who is all of those people between patients, plus the clinician, plus the one who unblocks the sink.

So the supplier renewal gets signed because reading it properly would cost an evening you do not have. The rep’s quote gets accepted because you have no way of knowing whether it is good. The energy contract rolls over. The merchant statement — four pages of interchange, scheme fees and a “non-qualifying transaction” line — goes in the drawer. Not through carelessness. Through arithmetic: there is one of you.

This is the real asymmetry, and it is bigger than volume. The corporate group is not smarter than you. It just has someone whose entire job is the thing you do at 10pm.

And you cannot simply put your prices up

The obvious answer to rising costs is to charge more. Every owner knows why that answer is thinner than it looks. Your patients are living through the same cost-of-living squeeze you are. They are stretching the gap between appointments, choosing the cheaper option on the treatment plan, or ringing round for a price. A practice that raises fees twice in a year finds out quickly how loyal loyalty is.

And most owners do not want to. You did not open a practice to become the expensive one in town. The whole point of being independent is that you set the standard of care and the price yourself — not a pricing committee that has never met your patients.

Which leaves exactly one lever that raises margin without raising a single fee: what you pay for the things you buy anyway. Every pound taken off the cost base is a pound of margin your patients never feel. It is the only saving that is genuinely free to them.

The rollup is already here

And this is where the squeeze stops being a bookkeeping problem. Thin margins are how consolidation recruits. Very few owners sell because they stopped loving the work; they sell after a few years of costs outrunning fees, when the offer arrives in a month where the numbers were tight and the alternative is another decade of the same. Margin compression is the funnel. The acquisition is just the end of it.

If you own an independent practice, you have watched it happen. In veterinary, a handful of corporate groups now own a large share of first-opinion practices. In dental, corporates and DSOs have been acquiring practices for years — and the stated reasons are cost, not clinical: solo practices absorbing rising operating costs, supply inflation, staffing shortages and capital demands without the purchasing power a group has. Aesthetics, physiotherapy, optical and private medical are earlier on the same curve — but the direction of travel is identical.

The pattern is consistent: private equity backs a consolidator, the consolidator buys up independent practices, and it uses scale to squeeze cost out of the group. Nothing about that is illegal or even surprising — it is what scale is for. The question for an independent owner is simpler: how do you compete on cost without handing over the keys?

Why the consolidators pay less

A corporate group buying for 200 practices does three things an independent cannot easily do alone:

• It pools volume. One national contract for gloves, consumables, card processing or energy across every site unlocks pricing tiers a single practice will never reach.
• It employs procurement. Someone whose full-time job is to know what everything should cost, and to hold suppliers to it.
• It has data. Visibility of what every site pays for every line — so no supplier can quote one practice a worse price than another and get away with it.

The independent has none of these by default. You buy at the volume of one practice, you negotiate in the gaps between seeing patients, and you have no idea whether the price your rep quoted is the price the practice down the road is paying. Suppliers know exactly what everyone pays. You do not. That information gap is where the money leaks.

You do not have to sell up to get the price

The pitch from a consolidator is that scale is the only way to get corporate pricing — so you may as well sell. That is only true if independents stay atomised. The moment someone negotiates on their behalf, the scale advantage narrows sharply.

Two things give an independent practice corporate-grade buying power while staying fully independent: a negotiator acting on its behalf and shared data.

1. Let someone negotiate for you

A lot of what a practice spends money on has nothing to do with clinical specialism. Card processing, energy, insurance, waste collection, telephony — a dental practice, a vet, an aesthetics practice and a physio practice all buy these on essentially identical terms. There is no reason each should negotiate them alone at the volume of one.

An intermediary that represents hundreds of independents can negotiate with the weight of all of them behind it — the same lever the corporates pull, without anyone giving up ownership. That is the model: SupplyIndex negotiates the rate with the supplier and gives each practice access. Joining is free because the supplier pays to reach a large base of independent buyers.

2. Arm yourself with data

Buying power is only half of it. The other half is knowing what a good price actually is. A corporate procurement team negotiates from data; an independent usually negotiates from a feeling that the price seems high.

This is a solvable problem. When independent practices contribute what they really pay, it can be aggregated — anonymised and statistical, never any single practice’s figures — into a benchmark of what the market actually pays. That turns a vague "can you do anything on price?" into "my per-unit cost is above the market median and I’d like it brought in line."

SupplyIndex is building exactly this: procurement benchmarks built from real prices paid by independent practices. Benchmarking is coming soon — the more practices contribute, the faster it becomes useful, and the harder every deal can be negotiated on members’ behalf. Contributing also helps us spot where you are overpaying today.

Five sectors, one supplier base

The reason this works across dental, veterinary, aesthetics, allied health and private medical at once is that they share so much. Gloves, PPE, sharps and clinical waste, card processing, energy, indemnity and insurance — the supplier lists overlap heavily. An independent vet and an independent aesthetics practice are, from a procurement point of view, buying from many of the same people.

That shared base is what makes it work. Every independent that joins makes the benchmark denser and the negotiating base larger — for everyone, in every sector.

What to do now

• Read where margin quietly leaks away and work down your own list — it is an afternoon, and it is the fastest money in the practice.
• Document your real per-unit and monthly costs for the handful of things you spend most on.
• Take the negotiated deals that need no scale on your part — card processing first, more by demand.
• Contribute your invoice data so the benchmark builds and negotiations get sharper.
• Register the categories you actually want deals in — that is what decides which we open next.

Consolidation is not slowing down, and neither is the April invoice. But the case for selling up rests on independents staying isolated — one owner, one practice’s volume, no idea what anyone else pays. Let a negotiator work on your behalf and you keep both the price and the practice.