Ep 99 My Experience Leaving the NHS

For more than 20 years, the NHS was my professional home. I trained as a dietitian, built my clinical expertise and progressed through leadership roles that I had worked incredibly hard to achieve. On paper, my career looked successful. I had reached Band 8B consultant level, something very few dietitians achieve.

And yet, despite loving my profession, a quiet question kept appearing in the background of my mind.

Is this it?

If you are a dietitian working in the NHS and you have ever asked yourself that same question, you are not alone. This blog is not about criticising the NHS or dismissing the incredible work that clinicians do every day. The NHS shaped my career and gave me experiences I will always value.

This is simply my honest story of leaving the NHS as a dietitian and transitioning to private practice, and the lessons I learned along the way.

Reaching the Top of the Ladder

When I first qualified as a dietitian, I felt genuinely proud. After years of studying, placements and exams, I had finally made it into the profession I cared deeply about.

Over the years, I progressed through increasingly senior roles. I spent seven years in leadership positions, managing teams and taking on more responsibility.

Eventually, I reached consultant level as a paediatric dietitian at the age of 41. In many ways, this was the pinnacle of my clinical career.

But reaching the top of the ladder created an unexpected feeling. I realised there was nowhere else to go.

And that realisation sparked something uncomfortable. I began to feel restless.

I loved working with patients. I worked in paediatric diabetes and the clinical work itself was deeply meaningful. I ran cookery sessions, visited schools and supported families through incredibly challenging diagnoses.

But alongside that fulfilment, another thought kept returning.

I wanted more.

More challenge.
More creativity.
More flexibility.
And yes, more income.

It took me a long time to admit that last part out loud.

The Guilt of Wanting More

Many healthcare professionals struggle with this.

When you have a secure NHS job, a pension and a respected role, it can feel uncomfortable to admit that you want something different.

For a long time I asked myself questions like:

Who am I to want more?
Am I being ungrateful?
What will people think if I leave?

That internal conflict stayed with me for years.

I remember long walks with my husband when we were visiting my parents in Spain. My mum and dad would look after the children while we walked the dogs and talked about work, life and what the future might look like.

At the time, I wish someone had told me this:

Wanting more does not make you ungrateful.

You are allowed to love your profession and still want your career to evolve.

The Red Tape That Limited Creativity

Another factor that influenced my decision was something many clinicians will recognise immediately.

Red tape.

The NHS operates within systems and policies that are designed with good intentions. But those same systems can sometimes limit how much impact clinicians can have.

For example, I once wanted to create a new patient leaflet. It had to go through a committee process that would take six months for approval.

Six months.

As clinicians, we want to move quickly when we see opportunities to help patients. But the structure of the system can make innovation difficult.

There were also moments when I was told to reduce the number of school visits I was doing. Yet those visits were the only way some children with diabetes could access support.

Experiences like that made me feel increasingly restricted in how I could practise as a clinician.

The Life Event That Changed Everything

For years, these thoughts stayed quietly in the background.

Then in 2018 my mum passed away.

Grief has a powerful way of shifting your perspective on life. Suddenly the idea of waiting for “someday” no longer felt comfortable.

Life felt too short to stay stuck in something that no longer felt aligned.

But my decision at that point was not to leave the NHS immediately.

Instead, I made a different commitment.

I decided to take my private practice seriously.

From Side Hustle to Serious Business

For years, I had a small private practice running quietly alongside my NHS job. Referrals came through colleagues, doctors and directories like Bupa.

But it was never something I prioritised.

After my mum died, that changed. I began to explore whether this private work could become something sustainable.

I also became fascinated by the idea of leverage.

In clinical work, income is usually tied directly to time. You see a patient, you get paid. If you stop seeing patients, the income stops.

But what if there were other ways to share your expertise?

During a few months spent supporting my dad in Spain, I started listening to business podcasts while walking. Shows like Amy Porterfield’s Online Marketing Made Easy and Pat Flynn’s Smart Passive Income opened my eyes to a completely different world.

I started learning about digital products, online courses and new ways of delivering expertise.

My First Online Sales

Curiosity led me to experiment.

I created a couple of children’s portion size guides and sold them as simple PDFs from my website. They were small resources priced at £9.99.

They were not groundbreaking.

But when those first sales came in, something clicked.

It was proof that my expertise had value outside the clinic room.

It was proof that I could help people without needing to be present every single time.

And most importantly, it showed me that building something online was actually possible.

Doubling My NHS Salary

Once I saw that proof, I began to experiment more seriously.

I focused on building income streams that could scale, including:

Digital resources
Online courses
Affiliate income
Ad revenue from my blog

I tested ideas slowly while continuing my NHS role.

Within less than two years, something extraordinary happened.

I doubled my NHS Band 8B salary.

In one year I generated £124,000 in revenue, without increasing my patient appointments.

That moment was the turning point. It showed me that leaving the NHS as a dietitian could become a realistic option.

The Unexpected Opportunity to Help Other Dietitians

Then the pandemic arrived in 2020 and everything changed.

Many colleagues began reaching out to me. They had seen what I was building online and were curious about how it worked.

Some wanted to start private practices. Others needed to move their existing work online.

At first, I simply shared what I knew.

I answered questions.
I pointed people towards resources.
I helped informally.

It never occurred to me to charge for this support.

But eventually my business coach pointed something out.

I was already coaching people.

That insight led to the creation of my second business supporting dietitians who want to build sustainable businesses.

The Moment I Finally Left the NHS

In January 2021 I took on my first seven coaching clients.

Just one month later, in February 2021, I handed in my notice.

After more than 20 years as a dietitian in the NHS, I stepped into a completely new chapter of my career.

Leaving was emotional. The NHS had shaped my identity as a clinician.

But I knew it was the right time.

What I Want You to Take From This

If there is one message I hope you take away from my story, it is this.

You are allowed to love your profession and still outgrow your current role.

You are allowed to want more flexibility, more income or more creativity in how you work.

And you do not have to blow up your life overnight to make a change.

You can build slowly.
You can experiment.
You can give yourself proof before taking the leap.

That is exactly what I did.

Want Help Exploring Your Own Next Step?

Today I work with dietitians and healthcare professionals who want to build ethical, sustainable businesses alongside or beyond clinical work.

This is not about unrealistic overnight success. It is about helping you:

Create offers that do not rely solely on one to one time
Build income streams using your expertise
Position yourself confidently as an expert
Grow a business that gives you more flexibility and options

If you are curious about what that could look like for you, the best place to start is with a conversation.

You can book a free 20 minute discovery call here:
https://thechildrensnutritionist.as.me/discovery 

You do not have to figure this out on your own.

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/

Instagram: https://www.instagram.com/dietitiansinbusiness/

Facebook: https://www.facebook.com/dietitiansinbusiness

Facebook Group: https://www.facebook.com/groups/beyondtheclinicbusiness

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

Episode transcription:

Today I wanted to talk openly and honestly about my experience leaving the NHS after over 20 years as a dietitian. Whether you've already left the NHS and you're navigating your next steps in your business or you're still in it right now, wondering if you'll ever feel brave enough to step away, then this episode is for you. Or maybe you're just a bit nosy and you're here for the tea of what actually happened behind the scenes.

The first thing I want to make clear is this isn't an episode about NHS bashing or criticising the system or the people in it or the profession that I was proud to be part of. Not at all. It shaped me as a clinician. It gave me experience I will always value and it gave me the credibility and a ton of friendships too. This is about being honest about the moment that I realised it no longer fit the life that I wanted. It's about

telling the truth of my experience, not to persuade you to do the same, but to help you make sense of what you might be feeling and to normalise the thoughts that you might be too scared to say out loud. I'll be diving deep into the behind the scenes of what I was really feeling whilst in the NHS, a lot of which I'm sure you'll be able to relate to, as well as the moment I decided it was time to go all in on my private practice. You'll get an insight into the things I prioritised

in the very early stages of building my business.

and the things I invested my time into learning. So grab a cuppa and let's start at the beginning.

When I first qualified as a registered dietitian, I was ecstatic, genuinely ecstatic. I remember thinking I've made it. After all of those years of studying, the placements, the exams, the repeated first year, and suddenly I was an NHS dietitian. I was so proud, proud to be part of something bigger than me and proud to introduce myself and say what I did.

Then as the years went on, I progressed and climbed the ladder. I was in leadership roles for seven years. I managed teams. became dietetic manager, then divisional director, then AHP lead. And each time I moved up the ladder, there was that same feeling again. I've made it. I've worked so hard to get into these roles. And by the time I became an AB consultant dietician at just 41, I'd essentially reached the top of my ladder in my field.

Now on paper, it looked like a very successful career. And in many ways, it was.

That's why what came next was so confusing because when you've achieved the titles that you worked so hard for and you've climbed the ladder, you've gone into management, you've gone back into clinical, you expect to feel settled and content, right? But instead I found myself thinking, is this it? And these feelings had nothing to do with enjoying my work. I absolutely loved being a dietitian.

I worked in pediatric diabetes. I cared deeply about my patients. I got to hang out with them in school. I got to do home visits. We did cookery classes. It was just brilliant. I got such a buzz out of helping make a difference to these young people's lives. And you know what? I still do. So what was it about? Well, there wasn't one pinnacle moment where I thought, can't do this anymore. There wasn't a big incident that forced my hand.

It was a combination of lots of different things that ultimately led to me leaving the NHS. So the first thing was realising that there was literally nowhere left to go. I'd reached the top of the ladder. I'd done it for the last seven years, switching from role to role to role. And on paper, I'd achieved everything I'd set out to do. And yet there was this quiet feeling that I wanted more, more challenge, more variety and yes, more income.

And I'm very open about this because wanting more isn't greedy

And wanting more doesn't compromise your ethics in any way, shape or form. I had the experience, the expertise, the results. There was no reason not to crave more. And of course it wasn't all about the money. I genuinely loved the work itself and being part of a meaningful change that had always been the heart of why I became a dietitian. But at the same time, the money did matter. It's important to say that out loud.

Wanting to be fairly compensated for your skill, your time and your expertise is 100 % fair. So to all of you listening, let that be a reminder to start recognising the value of what you bring to the table and start normalising saying, I want more.

In saying this, in the early stages of feeling like I wanted more, I felt so much guilt for it because this was a good job with a really good pension. And I was like one of only five pediatric dieticians at this level in the country. So at first I found myself asking, who was I to want more? Who was I to feel restless and dare I say, bored with my role?

I worried a lot about what other people might think if I was to leave my friends, my family, my NHS colleagues. I worried people would think I was ungrateful or irresponsible. And the internal conflict sat with me for a long time. I'll never forget all those years ago when me and my husband would go on long walks when we were at my parents' house in Spain. My mum and dad would be keeping an eye on the kids and me and my husband would be on these long walks with their dogs.

talking about how I was feeling about work and the potential possibilities that were out there. I wish I could go back to that time and tell myself that wanting more didn't make me ungrateful or selfish.

I so wish I could go back and tell myself that Sarah, you blooming well did it.

The other big factor that led me to starting my own business was down to what I call the red tape effect. something that quietly limits skilled clinicians. No matter how good you are at your job, how committed you are to your patients or how much you care, the NHS comes with its own invisible barriers that limits how much impact you can have within the system.

Certain policies are designed with good intentions, but they can create a ceiling on how much you can actually do and how freely you can use your

you've had a similar experience to me here. I'm a big believer that red tape massively limits good clinicians. And for me, it was just another factor that led me to where I am.

know, simple things like wanting to create a certain type of leaflet for my patients and having to run it through a paper group committee, which would take six months to be approved.

being told I had to reduce the number of school visits I did. And yet these kids didn't come to clinic. It was the only way that I could get to them and educate them on managing their diabetes.

Those limitations, they really did impact my creativity and how well I could be a clinician. But despite all of this, and despite very clearly wanting something more, I stayed where I was for years actually, feeling this way, until a moment came when my life completely changed. So in 2018, my lovely mum passed away and losing my mum forced me to re-evaluate

everything, not just work, but everything in life. Grief has a way of doing that, doesn't it? It brings perspective whether you're ready for it or not. And life suddenly just felt too short to stay stuck in something that no longer fulfilled me. And it wasn't about disliking my job. It was about recognizing that the way I was working and the life that I was building around it no longer felt aligned. So up until that point, I'd been

managing quietly and telling myself I could keep going and maybe that this is just a phase and I'd tell myself that I'd think about changing things later but after my mum died I realised that I needed to stop waiting for later to come. So the decision I made at that point wasn't to leave the NHS, it was to stop treating my private practice as something on the side and to go all in on it because during this time

I was running my private practice as a bit of a side hustle. And that's when I decided it was really time to give it a proper go and see whether it could become a business that might eventually replace my NHS salary. So after that point in 2018, things didn't change overnight. I didn't hand in my notice there and then. What changed was how seriously I took the idea of building something alongside my NHS role.

So I already had this really well established private practice that had existed quietly in the background for years, decades. I had referrals from colleagues, from doctors, people finding me through directories like Bupa. But up until then, it had always just been there, but not by any means a priority or something I was taking seriously. But after losing my mum, I decided to stop treating it like a hobby.

and started really thinking about whether this could turn into something sustainable. Now, I made sure to approach this carefully, though. I didn't want more private patients just for the sake of it. I was already busy enough. I had two young children. But what interested me was leverage. Now, by leverage, I mean doing work once and helping more people without trading more of my hours for money.

So during my grief, I actually spent three months living at my parents' house in Spain, supporting my dad, sorting through my mum's things. And during this time, I started listening to business podcasts when I went out walking, like Amy Porterfield's online marketing Made Easy show and Pat Flynn, who had smart passive income.

And I was dedicating a lot of my time to learning and trying to understand how people were building businesses outside of traditional nine to five roles. And that's when I first came across the idea of different ways to generate online income, like the courses, like digital products. So resources that I could create once and sell again, again, and again. And at first it felt almost a bit too good to be true.

almost a little bit dodgy in a way, but I was really curious. So I experimented. I created a couple of children's portion size guides and I sold them directly from my website. They were low cost. They were 9.99 each. There was just five pages in a PDF. But when those first sales came in, something clicked. Not because it was life-changing money, but because it was proof. It was proof that my expertise

had value outside of a clinic room, proof that I could help people without needing to be present every single time, proof that this could actually really work. So then I spent a lot of time learning more, testing different things, failing here and there, tweaking and changing things as I went. And all of this happened alongside my NHS role. It wasn't about abandoning my work. It was about delivering my work in new and different ways.

And it didn't take me long to realize that this work was actually giving me a real sense of joy in a way that I hadn't had for a long time.

So from here, I knew I needed a plan of action. So I set myself a goal. I wanted to double my 8B NHS salary. My thought process at the time was if I hit that goal, I would know that my business was sustainable and I could do this. But I didn't want to see tons of patients I wanted flexibility in my life and in my work. So I focused on building things that I could scale, like the courses, like digital products.

And I also looked into other income streams like earning through ad revenue on my blog, as well as affiliate income from recommending other people's goods and services. And I learned how to do these things properly and ethically as a dietitian. And I tested things really slowly alongside my NHS role. Then in 2020, I reached my goal. I doubled my NHS salary in less than two years.

I made £124,000 in a year, which was double my 8B. And I did this all without seeing any more patients. And that was the moment. That was when I realized that, my goodness, I could totally do this.

And then the pandemic hit, course, and almost overnight, everything changed. Something unexpected happened quite quickly during this time. My colleagues started coming to me. They'd seen that I was making money online for this sort of 18 months before without seeing any patients face to face. And they were curious. Many of them were really worried because suddenly...

The NHS didn't feel quite as stable as it once had. It wasn't a really nice place to work at that point in time. And so they wanted to know how starting a private practice worked and whether it could be possible for them as well. And then I had other colleagues who already had well-established private practices, but in real life, and they needed to pivot and move things online. So at first, I just helped informally. I answered questions. I shared a bit about what I was doing and what I'd learned.

I sent people to go and read things and listen to things. I didn't charge anybody any money for this. I was just giving them free advice. It didn't even occur to me to charge for this advice, if I'm honest. But as time went on, people weren't just asking if it was possible. They were asking how. And around the same time, I decided to deepen my own knowledge properly. And I decided to learn even more about online marketing and meta was Facebook at the time, Facebook ads.

sales, of course, and course creation, but at a higher level, at master's level. And during this period, I was working with a business coach as well. And she pointed out that I was already helping and coaching people and that perhaps it was time to start charging for that support. I was a bit gobsmacked, to be honest, but that was the beginning of my second business, Dietitians in Business. That's when it was born. And so in January, 2021, I took on my first seven clients.

All dieticians who wanted to build something more sustainable for themselves and a month later in February 2021, I handed in my notice to the NHS. So that's it. That was my full experience of leaving the NHS after over 20 years as a dietician. Now, if there's anything I want you to take from this episode, it's this. You are allowed to love your profession and still want to evolve.

You are allowed to be proud of your career and still outgrow it. You're allowed to say, I want more without apologizing for it. And you don't have to blow your life up to make a change. You can build slowly and you can give yourself proof before you take that leap. So if you want to know more, but you don't quite know what that looks like yet, this is exactly why I now do the work that I do because I've been there.

I know what it feels like to love your clinical work, but to crave something more flexible. I know what it's like to want to earn more money without seeing more patients. And I know what it's like to worry about pensions and security and what your colleagues might say because I've navigated all of that. And when you work with me inside my business coaching, isn't about promising you unrealistic overnight success. It's about identifying what you could build based on your expertise.

about creating offers that don't rely purely on one-to-one time, about learning how to leverage your knowledge ethically and sustainably, about understanding pricing and positioning yourself and building income streams that give you options. I work specifically with health professionals because I understand the context that you're operating in as well as the regulations and our ethics.

And you definitely do not need to be figuring this out on your own. So if you're ready to explore what business coaching could do for you, you can start by booking a free 20 minute discovery call with me. You can find the link to book our call in the show notes of this episode.

Bye for now.