Why Private Healthcare Cannot Fix Staffing Without Admin

When healthcare workforce shortages are discussed, the conversation almost always begins with doctors and nurses. The statistics on clinical shortfalls are stark and well documented. According to the Royal College of Nursing’s 2026 analysis, NHS England advertised 23,046 registered nurse vacancies in August 2026, while the RCN estimates the true shortfall of nurses needed to deliver safe care is closer to 55,000. General practice is under similar strain. According to LaingBuisson’s primary care market analysis, the private GP market was valued at approximately £1.6 billion in mid-2024, with more than 550 CQC-registered services offering private GP consultations across the UK. 

But behind every clinical interaction sits another workforce, one that rarely appears in headlines. It is the administrative staff who manage scheduling, patient correspondence, referrals, billing, and medical records. Without them, clinical care cannot function. According to UNISON analysis published in April 2026, these are precisely the roles being cut in the name of efficiency. The union warns that upwards of 3,000 administrative posts are set to be eliminated in England over the next two years, and that, when factoring in outdated IT systems, this is a recipe for mistakes that may put patients at risk.

That risk is not hypothetical. A 2025 study by the Royal College of General Practitioners into the hidden workload of GPs found that 91% of GPs reported spending time navigating referral processes, with much of that work driven by fragmented administrative systems and duplicated responsibilities. According to the Royal College of General Practitioners, GPs in England may be losing the equivalent of £410 per GP per day to avoidable and hidden work. Meanwhile, a survey of nearly 600 practices found that 25% of respondents think that patient safety has been put at risk by recent access changes, while 60% of practices have seen GP partners working longer hours to compensate for system failures.

Aleksandra Stosic, founder of Doctor’s Secretary and co-owner of Lila’s Desk, has spent years working inside this administrative layer. Doctor’s Secretary supports numerous consultants and clinics across the UK, with Lila’s Desk created to extend that model to smaller clinics and individual practitioners who need flexible support without the overhead of a traditional agency. In her view, the problem is not simply that administrative staff are hard to find. It is that the way practices have traditionally hired them no longer fits the way they actually work.

Stosic explains that the traditional secretarial support model ties clients into packages with minimum monthly fees, whether or not the practice has that volume of work. “There is no single place to look for such flexible service,” she says. For a newly established consultant who does not yet know how many patients they will see, committing to a minimum spend before revenue arrives is a barrier. Lila’s Desk was built around the premise that clients pay for the hours actually worked and can scale up or down as their practice grows.

That flexibility matters on both sides of the arrangement. Stosic describes a workforce of trained secretaries who are often looking for something other than a full-time office role. Some are NHS secretaries seeking additional or freelance work. Some have worked in private hospitals and want to work remotely. Others have trained through Doctor’s Secretary’s medical secretary foundations course, including returning parents, former executive assistants, and people transitioning from other sectors. “You don’t need to be based in the UK,” Stosic notes. The platform reflects that, drawing on trained assistants across multiple countries.

What holds the model together, in her account, is the recognition that these are not transactional engagements. “The relationship between a consultant and a secretary is all about chemistry,” she says. “They’re two human beings working closely together.” Because the relationships tend to be long-term, Lila’s Desk assigns an implementation manager to ongoing engagements and runs an onboarding call with both the client and the secretary to ensure expectations are aligned from the start. Stosic describes clients who have tolerated underperforming secretaries for months simply because they feared finding someone worse. The implementation layer exists to remove that risk from the initial match.

The broader lesson is that healthcare workforce resilience depends on administrative capacity as much as clinical headcount. A practice can recruit the right consultant or GP, but if scheduling, referrals, and correspondence are not managed, clinical time does not convert into patient care. The employment model supporting that administrative workforce may need to evolve. For smaller practices in particular, the choice between an expensive agency contract and an unmanaged freelance arrangement may no longer be the only option.