Ep 94 - 4 NHS Habits That Are Quietly Killing Your Business

When I first left the NHS to run my own business, I thought I had a decent head start. 

Clinical skills? 

Experience? 

Work ethic? 

But what I didn’t realise was that I was still thinking - and operating - like an NHS clinician.
And that mindset? It was quietly slowing everything down.

I see this all the time with other healthcare professionals. You're not doing anything “wrong” - it’s just that some of the habits we developed in the NHS don’t translate well into private practice.

So today, I want to gently walk you through the four most common NHS-trained habits I see in new (and no so new) business owners - and how to start shifting them.

1. Waiting for Permission

In the NHS, permission is baked into everything. Want to design a diet sheet or patient handout? That needs sign-off. Changing a guideline? That’ll involve a committee & several meetings. Using a new phrase in patient education? Best to check.

This structure serves a clear purpose - safety, accuracy, consistency. It’s governance.

But in business? That same habit can quietly lead to hesitation.
You might second-guess every decision, stall on a great idea, or put off sharing your offers because no one has backed you up on it.

But - as a business owner, you don’t need anyone else’s go-ahead anymore.
You’re not in someone else’s system. 

You are the system now.

Try This Instead:
When you feel yourself pausing, ask:

• Is this evidence-based?
• Is this within my scope of practice?
• Is this going to help someone?

If the answer is yes - that’s your green light.

2. Seeing Clients as Patients

This one’s deeply ingrained - and very understandable.
In clinical practice, patients are referred to you. You’re there to assess, advise, support, and discharge. 

There’s no need to invite patients to come to you. Just imagine what would happen if you did? The waiting times would get even longer than they are today.

So when you move into private practice, it’s easy to assume that if you just make yourself available, clients will come. Especially when NHS waiting lists are so long.

But sadly building a business isn’t passive. It requires work and that starts with intentional visibility and clear marketing inviting clients to work with you.

I often see healthcare professionals create beautiful websites and useful Instagram content - but never actually talk about how to work with them. Or why it matters. Or what transformation is possible. 

And they don't get as many clients as they’d expected.

Shift to Make:
Start thinking of yourself as someone who invites, not just informs.
And for every piece of content you create, ask:
Have I clearly explained how someone can take the next step?

That single habit can change everything.

3. Fear of Branding Yourself

This is one I really had to work on personally.

In a traditional healthcare setting, you’re known by your role: “the dietitian,” “the physio,” “the nurse.” You’re part of a team, and your identity is often tied to your profession, not your individuality.

So when it comes to putting yourself out there online - sharing your face, your story, your why - it can feel a bit… exposed. Even (dare-I say) unprofessional.

But in business, people need to know you - not just your qualifications.
And it’s your values, your perspective, your approach that help people feel safe enough to say, “Yes. I want to work with them.”

Simple Shift:
Start using “I” in your content.

“In my experience…”
“What I often see with clients…”
“This is how I approach it…”

That small tweak moves your content from impersonal to personable - and helps potential clients build trust.

4. Waiting for Permission to Earn More

This one goes deep into your subconscious.
In the NHS, salary bands are fixed. Progression is tied to time, banding or role changes. 

Earning more is always predictable, structured - and quickly hits a glass ceiling.

So when you move into private practice and realise you can decide your rates? It can feel… odd.

That’s when the internal dialogue starts:

• “Is this too much to pay?”
• “What will people think if I have higher prices than other freelancers?”
• “Am I allowed to charge this much?”

You are. And you must.

Because when your pricing reflects the value you provide and the life changing impact you deliver - and allows your business to thrive - everyone benefits. You can help more clients, create a bigger impact, and ensure your business is sustainable.

Try This Reframe:
Pricing isn’t about greed. It’s about charging in a way that supports both you and your clients.
You’re building something that needs to last - for you, and for the people who need your help.

Reflection Prompts

If any of these habits are resonating (and I’m sure they will for many of us!), try sitting with one or two of these questions:

1. Where in my business am I still seeking permission - and why?
2. Do I find it hard to talk about myself or my work publicly? What might help me ease into it?
3. What would change if I allowed myself to earn in proportion to the impact I’m creating?

Ready to Shift From NHS Habits to CEO Thinking?

Inside Accelerate, my business coaching programme for healthcare professionals, we focus on both strategy and mindset - because both matter.

I help you unlearn patterns that are no longer serving you, and replace them with confident, grounded business thinking. You’ll get practical tools, honest support, and the clarity to grow your income without burning out.

🗓️ Click here to book a discovery call
I’d love to chat and see how I can support your next step.

The Master Plan:

Helping you build the business of your dreams. Get your 22 point step-by step workbook here: https://www.sarahalmondbushell.com/master-plan

Connect with me:

Website: https://www.sarahalmondbushell.com/

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YouTube: https://www.youtube.com/@BeyondTheClinicPodcast

Episode transcription:

Welcome along. It is Monday morning. I have just got back from a business event this weekend, Friday and Saturday. I went to Expert Empires in London with a colleague actually, which is a kind of CPD event for people in marketing and in business. And you know what? It was great. It was great. Don't get me wrong. I really enjoyed it. I love listening to speakers and I love learning. So it was really good from a CPD point of view.

But I have to tell you, the keynote speaker for the entire event was a chap called Eddie Abbew, you may have come across him. He is a influencer. He's got 3.4 million followers and he talks a lot about nutrition without being qualified in nutrition. He does have a background as a psychiatric nurse, but decades and decades and decades ago. And if you're a dietitian like me, you will know that psychiatric nurses don't get a huge amount of training in nutrition. And he's also a bodybuilder.

And my goodness, sitting through and listening to this keynote speech about all the things that the public were doing wrong about what they were eating just boiled my blood. You know, he was saying things like, if you eat eggs that have been stored in the fridge, you're going to get constipated. Fruit should only ever be consumed at certain times of the year. Humans are not meant to eat it at other times of the year.

He talked a bit about fasting and how we were never supposed to eat breakfast. He talked about how plant-based diets and veganism was completely the wrong things to do for the human body. And we were designed to eat meat. Honestly, I cannot tell you how much my blood was boiling. And to be honest with you, I was intrigued to see what he was going to say about growing a business on social media. I was hoping there was going to be some things I could learn from the social media side of things.

But I just couldn't bear to sit there any longer. So my colleague and I, we got to the point where we just up and left. We couldn't sit there any longer. We had to vacate the place. So it was just a little lesson for me just to remind me of my passion for exactly why I do what I do. It's really important for me to be able to support other healthcare professionals, get the right information out there for people, get the right help and advice and help the public. The more I can help you, the more you can help your clients and the world will become a better, healthier place. That's what it's all about for me.

Anyway, I digress. In this episode today, I'm going to be talking through some NHS habits that you know what will absolutely kill your business. And I want to start with a question to ask yourself. Have you ever considered how the habits that you might have learned in your time in the NHS could actually be secretly holding you back from growth in your business?

Now, the reason I'm asking this is I recently did a post on Instagram and I was so surprised actually, my DMs were full of messages from people saying, my goodness, I do all of these things. And I really do think that one of the biggest reasons that so many of us healthcare professionals struggle, especially in those early stages of growing a business, is because we're carrying over habits that made us incredible clinicians, but actually they don't serve us very well at all when it comes to running a business. And so today I want to unpack this properly.

So we're going to talk about how your NHS trained habits might actually be secretly making business harder for you. And by the end of this episode, I hope that you'll start to spot the habits that you didn't even realize that you had that are holding you back, understand why they're there, and then also learn some practical ways to break these old patterns and create new ones. And you're also going to begin shifting your mindset from thinking like a clinician, still in the NHS, to thinking like a business owner and CEO so that you can grow your business confidently, but without losing the values and the integrity that make you an amazing healthcare professional in the first place.

Okay, let's dive in. So the first habit that we tend to adopt is waiting for permission. So if you think back to your NHS career, perhaps you're still there, how many times did you have to get approvals, get sign-offs or clearance for doing something? It could be anything, you know, from treatment plans to whether you were allowed to create a diet sheet or a handout or a leaflet for a client. It could be clinical guidelines. Everything had a layer of approval, a committee that had to sign off on what you were doing. And over time, you internalize this habit of waiting for permission before taking action and it's great because in the NHS, it keeps us safe, it keeps us accurate, exactly what you need in the clinical setting. But in business, waiting for permission can actually be a massive barrier to your growth.

So, for example, you might find yourself hesitating to talk confidently about your services. You might not realise it, but it's likely because you're still waiting for that external validation before you feel allowed to speak with authority. Or you might find yourself procrastinating on an idea for a new offer. You might not realize it, but it's likely because you're subconsciously waiting for that reassurance that you're doing it the right way. Or you might hesitate to post on social media, for example. Again, it's likely because you're still waiting for someone to tell you that what you're about to say is okay, or it's accurate enough, and you won't get into any trouble. And all of these behaviors are happening because we're still operating as if someone needs to give us permission.

And these behaviors, they have one thing in common. They just slow your business down. So what needs to change? So the first thing you need to keep reminding yourself is that you are no longer operating inside of an organization, of somebody else's system. The governance is yours to manage. In business, there isn't someone there to give you permission. You create the rules now, and that can feel a bit uncomfortable at first, but you know what? It is absolutely essential for growth.

So one way to start breaking the waiting for permission habit is whenever you feel yourself hesitating, just take action. You can ask yourself questions like, is this evidence-based? Well, yes, of course it's going to be, but you know, just ask yourself that if you need to. Is this within my scope of practice? That's a really good one as well. And is this going to be helpful for the people that I want to support, that I want to help? And you know what? If the answer is yes, that's your permission. That is all you need.

Okay. The second NHS trained habit that can quietly hold your business back is seeing clients as patients. So in the NHS, our work comes via referrals. Your diary is filled for you. You don't have to sell yourself. Your role is to assess, to provide care, and then to move on to the next patient. So as a health professional, when you leave the NHS and you start private practice, that conditioning shows up in a lot of different ways. So you can fall into the habit, whether you realize it or not, of waiting for clients to find you instead of actively inviting them to work with you.

So for example, the classic mistake that most healthcare professionals do when they first start a business is create a website, maybe create a social media profile for their business, put themselves on some directories like medical insurance, freelance dietitians group, nutritionist resource, that sort of thing. And then just sit back and wait for the clients to show up. But that doesn't happen. Even if you have an amazing website, even if you post lots on social media, that's not enough for people to book in to work with you. Or on social media, for example, you might share loads and loads of helpful tips and advice in your posts or even in DMs, but you forget to talk about your offers. You assume people know that you're a dietitian or a healthcare professional and what it is that you do.

You forget to talk about the value of working with you and the benefits that that person will receive from spending some time and having their diet assessed or whatever it is that you do, working one to one with them or even in a group with them. And the reason why we hesitate doing that is because it can feel a bit salesy and you might feel uncomfortable talking about money, how much you charge, or even outcomes, because at the end of the day, when you were in the NHS, our patients weren't buyers. They weren't parting with their hard-earned cash. They were coming along because their doctor had told them to come along. Their other healthcare professional had suggested they see a dietitian.

Or you might assume that people will just say yes if they know that they need you. So you don't practice explaining your offer clearly. And you know what? Only a tiny of people actually know they need to see a dietitian. There's a whole range of people out there, massive volume of people who sit with their problems and their issues, but they don't yet know that there's a solution. Then there's another pool of people who have the problem and do know that there's a solution, but they don't yet know that perhaps it's a dietitian or a nutritionist or a health care professional who provides that specific solution.

There's another pool of people who do know that the dietitian is the right healthcare professional for them, but they don't necessarily know you. And so they're looking around at different healthcare professionals. So we have to tap into all of these different stages of people's awareness in order to attract people to us so that they become our clients.

So what needs to change? So the shift here is recognizing that you're no longer a clinician inside a system and you're moving from that clinician mindset to the CEO mindset. So in business, your role isn't just to inform people, it's to invite people. So whether that's in the DMs, whether it's in your social media content, whether it's in your blogs or your podcast or your YouTubevideos, you want to get into the habit of saying you know what if you want support like this here's how I can help you, or this is who my work is for and this is what working together actually looks like.

So a really simple place to start this is for every piece of educational content that you put out there that you share, just ask yourself, have I actually shown people how to take the next step?

Okay, I'd love to know how many of these are relating to you so far. So there's two more really common habits that I see all the time with health professionals in business. And these are often the ones that cause the biggest frustration without you actually realizing why. Okay, so the third habit that we're gonna talk about is the fear of branding yourself. And I'm gonna explain exactly what I mean by that.

So in a clinical setting like the NHS, your identity is tied to your role, not your personality. You are the dietitian, you are the physio, you are the nurse, you are trained to represent your department and your profession and not yourself. So when you move into business as a clinician, it can often feel quite difficult to express your personality, your lived experiences and you know what, even your values, it might feel a bit exposing. It might actually feel unprofessional and maybe even slightly inappropriate at times. You might feel really uncomfortable putting your face or your name to something and stand in front of a camera. You might find yourself thinking, who am I to put myself out there like this? And you might avoid talking about your own personal stories, why you do what you do because it doesn't feel natural.

Now this habit around the fear of branding yourself can massively hurt your business growth because people trust people. People buy from people they don't buy from businesses. So your personality, your lived experience, your values are what help people trust you and feel safe enough to say, you know what Sarah? It's you that I want to work with. And when you don't allow this to come through, your content blends in instead of standing out. So potential clients, they can't really see why they should choose you over the next professional who offers the same service. So again, here's what needs to change. How can us health professionals get out of the habit of fear of branding ourselves?

So one really easy way to do this is to start using 'I' language. So for instance, in my experience or what I've noticed is, or this is how I approach this with my clients. So simply just using the word I helps to move your content from generic education to something people actually feel connected to. It's so simple, but it's so effective.

Now the fourth and final NHS trained habit that we're going to dive into is a big one and it's waiting for permission to earn more money. So in the NHS, your income was largely fixed. You had a set salary, often tied to your band, and any pay progression would only come through things like your annual increment or if you moved into another role. So money in the NHS is predictable. It's structured and actually it's completely out of your control. And that structure teaches a very specific habit. You have to wait for permission in order to increase your income. But when you move into business, that old mindset often comes along for the ride. And suddenly you're in a world where you can earn so much more, the potential is huge.

But something inside of you says, am I allowed to do this? Is this too much? Well, people think I'm money hungry if I charge that. And that's exactly what I hear over and over and over again from health professionals starting their businesses or even health professionals who have been in businesses for a long time. They'll tell me things like, it doesn't feel right charging this much. My colleagues would just think I'm so greedy or I don't feel comfortable putting my prices out there. Or I'm really worried that people are gonna judge me for wanting to earn more. I'm just not gonna put my prices on my website. People will have to inquire and we'll talk about it when we're on a discovery call. So it's completely normal to have these feelings, especially if you've been in the NHS for years and years because money can almost feel a bit taboo, but you know what? It really shouldn't be. So as clinicians, we should all be able to earn fantastic amounts of money.

And if the NHS can't provide that level of reward or flexibility, then it is up to us to create it ourselves in a way that aligns with our values, that reflects our expertise and also the impact that we can have on people's lives. So what happens when we take this waiting for permission mindset around money into business? Well, you tend to underestimate your worth. You tend to offer your services at rates far below the value that you deliver to clients. You might avoid creating premium packages or hesitate to put your prices up.

So how can we change our mindset around this and stop waiting for that permission to step into a higher level of earning? Well, the first thing to remember is you really do not need permission. You're no longer in a system with that set banding and the pay reviews. You decide what your work is worth. And then you need to start reframing your perspective on money. So think of pricing as a tool to serve your clients better. Fair fees allow you to provide quality support and sustain your business's growth. Money is actually the enabler of impact and it's not the enemy of your values.

And the next piece is to start taking small but practical steps towards changing that mindset. So start testing out new pricing, start thinking about what a more premium offer could look like, or start having more confident money conversations with potential clients. Each time you act that old NHS habit just tends to lose its grip over time.

So I'd love to know which of these habits have you related to most? Waiting for permission to take action? Seeing clients as patients? The fear of branding yourself or waiting for permission to earn more money? Or maybe you've spotted them all showing up in your business. Well, let me tell you, I have struggled with all of these too. I know for a long time after leaving the NHS and starting my own private practice as a children's nutritionist, I carried each of these four habits into my own business. I was always subconsciously waiting for permission to take action, especially when it came to posting on social media in those early days. I remember posting on Instagram used to feel terrifying, like I was about to break some unwritten HCPC rule by hitting post.

And I spent far too much time waiting for permission that, you know, no one was ever going to give me. For a long time, I was also guilty of seeing clients as patients. I was posting tons of helpful tips online because I just wanted to help people. And I actually ended up growing a really big and engaged audience, but I wasn't selling very much back then.

And I can also 100 % relate to the fear of branding yourself because the thought of talking about myself felt foreign for a long time. Even simple things like putting my photo of myself on social media, it just felt really exposing. But over time, I realized that I needed to get comfortable with being uncomfortable if I wanted to succeed in my business. I realized that sharing my personality, my experience, my perspective, my views, my opinions on things was actually the only way that people could get to know me and trust me and then of course want to work with me.

And then last, but definitely not least, I spent a long time waiting for permission to earn more. I remember worrying that if I charged too much, people would just think I was money hungry. And I remember delaying raising my prices for months and months because I felt uncomfortable putting higher numbers out there, even though I knew the value that I was delivering, until I realized that I don't need permission to earn what I'm worth. I had to honor my own time and my expertise and the sustainability of my business. And you know what? So do you.

I really hope today's episode helps you start spotting the NHS habits that might be quietly holding your business back and gives you the perspective and the confidence to start unlearning them. Hopefully now you can see why those patterns show up, how they've been shaping your decisions and most importantly, what you can do differently so that you can grow a massively successful and profitable business, but without losing the values that make you such an amazing health professional.

Now, for those of you interested, inside Accelerate, my business coaching program, we don't just dive into the practical side of running a business, things like marketing and sales and creating profitable offers and systems. We also spend a lot of time on mindset work because this is often where the biggest transformation happens. I truly believe that mindset underpins everything. I'm a certified mindset and life coach. I've been through these mindset changes myself.

And that experience combined with that training means that I can help you unlearn those old patterns and replace them with confident business owner thinking. So if this resonates and you'd like to explore whether Accelerate could be a good fit for you, there's a link in the show notes to book a discovery call. And I'd love to chat to see how I can support you in growing the business and life that you're so worthy of and more than capable of building. Bye for now.