Why independent psychiatry pay looks the way it does
Independent and digital providers pay above trust rates for consultant psychiatry because they are buying scarcity and speed, not because the work is easier. The scarcity is real: adult ADHD, ASD and general adult community psychiatry all have more demand than there are consultants willing to hold the caseload.
What varies wildly is what the rate includes. A £450 assessment fee that covers a ninety-minute appointment and a full diagnostic report is a very different job from a £450 fee where the report is written in your own time. We insist providers state this on every mandate, and we will tell you when a headline number is doing work it should not be.
Supervision is the part people underestimate
Most independent providers scaling assessment capacity need consultants for two things: to assess, and to supervise the specialty doctors, ANPs and psychologists doing the volume underneath. The second part is usually where the job actually lives.
A defensible supervision ratio is roughly one supervising consultant per six to eight assessors. If a provider is asking you to hold twelve or fifteen, you are being asked to carry clinical risk that the operating model has not funded. That is a question to ask in a first conversation, not a third.
Right to Choose changed the market
Right to Choose pathways pulled a large volume of adult ADHD and ASD assessment out of trust waiting lists and into independent providers. That created genuine consultant demand, and it also created a tier of providers whose clinical governance has not caught up with their referral volume.
The difference is visible if you know what to ask. Who is the responsible clinician for the pathway. What proportion of assessments are audited. What happens when an assessor disagrees with a triage outcome. How titration is supervised and who holds the shared care conversation with the GP. Providers with good answers tend to have low clinician turnover, and we can tell you which ones those are.
Remote, hybrid and where you actually sit
Adult psychiatry assessment is now predominantly remote in the independent sector, with in-person retained for complex presentations, older adult work and some ASD assessment where observation matters. Child and adolescent work is more mixed.
Remote does not mean unsupervised. The better providers run a live MDT, a duty consultant line and a structured second-opinion route. If a remote role has none of those, you are a sole practitioner with a platform login, and your name is on every report.
How Scale Health handles psychiatry mandates
Assessment fee, appointment length and whether report time is paid stated on every brief
Supervision ratio confirmed with the provider before we introduce a candidate
GMC specialist register, Section 12 and approved clinician status verified during credentialing
Sessional, salaried and portfolio options across the same provider set