Private Practice Pricing in the UK: How to Set Self-Pay and Insurance Fees in 2026

By Caretalyst · Published 2026-05-20 · 12 min read

The pricing problem most UK private clinicians get wrong

Most privately practising clinicians undercharge at the very point of highest value: the first assessment. They also confuse cashflow with margin. A diary that looks full can conceal a 30–40% margin leak once you add room hire, admin time, unpaid clinical work (letters, forms), card fees, DNAs, and the time cost of insurer authorisations. The result is predictable: creeping burnout and a practice that never throws off the cash to hire help, improve patient experience, or build resilience.

Pricing is not about what you “feel comfortable” charging. It is a series of operator decisions: your floor (what it costs to deliver an hour), your anchor (the credible market range), your differentiation (why you can sit at the top of that range), and your packaging (how to present value so patients commit to a course of care). Get it right and you improve quality and access: you can invest in triage, outcomes tracking, and rapid response. Get it wrong and insurer schedules set your economics for you.

If you have not yet built a cost model, start there. Our guide to UK private practice setup costs breaks down common expense lines. For a revenue-side deep dive, see our playbook on revenue optimisation strategies.

The 2026 UK private healthcare fee landscape

Below are self-pay ranges we see across London and major UK cities. They are indicative, not prescriptive; your subspecialty, wait times, outcomes, and brand all matter. Check comparable consultants via hospital websites and the Private Healthcare Information Network (PHIN) consultant pages (see PHIN).

• Psychiatry (adult):
  • Initial assessment (60–90 min): £300–£450 Central London; £200–£350 rest of UK
  • Follow-up (30–50 min): £180–£300 Central London; £120–£220 rest of UK
• Clinical Psychology (50–60 min): £140–£180 Central London; £100–£150 rest of UK
• CBT/Integrative Psychotherapy (HCPC/BABCP/BACP registered, 50 min): £100–£140 Central London; £70–£110 rest of UK
• GP private consultation:
  • 15 min: £90–£150 Central London; £75–£120 rest of UK
  • 30 min: £140–£220 Central London; £100–£170 rest of UK
• Plastic surgery consultation (non-cosmetic/cosmetic): £200–£300 Central London; £150–£250 rest of UK
• Dermatology:
  • Initial: £220–£320 Central London; £170–£260 rest of UK
  • Follow-up: £160–£240 Central London; £120–£180 rest of UK
• Orthopaedics:
  • Initial: £260–£350 Central London; £200–£300 rest of UK
  • Follow-up: £180–£250 Central London; £140–£200 rest of UK
• ENT/Paediatrics/General Medicine (broadly similar to dermatology ranges above)
• Physiotherapy (30–45 min): £75–£110 Central London; £50–£85 rest of UK

Location adjustments in London:

• Harley Street/Marylebone/Belgravia: typically +10–25% vs outer London due to brand and room rates.
• Zone 2–4 clinics: mid-market pricing. Many successful clinics run a two-tier model: central premium day and outer-London standard day.
• Telehealth: usually at parity with in-person for psychiatry/psychology; for physical exam-dependent specialties, 10–20% lower for virtual triage where clinically appropriate.

Check local hospital and consultant sites; the Competition and Markets Authority also expects fee transparency, with PHIN publishing standardised information on fees and outcomes in the independent sector.

Self-pay vs insurer rates: the real economics

Insurer tariffs are not neutral. They shape your practice economics and your calendar. A few realities to ground decisions:

• Bupa: Operates “Fee Assured” schedules. If you sign as fee-assured, you agree not to bill shortfalls. Rates vary by code and region. For common outpatient consults, you’ll often see psychiatry/medicine follow-ups around the £120–£160 mark and surgical specialties a bit higher. Expect to trade off price for volume and faster payment cycles (7–14 days via eBilling). Admin overhead: pre-authorisations, coding, and occasional clinical justifications.
• AXA Health: Similar “Approved” schedules for recognised providers, generally comparable to Bupa and likewise no balance billing for fee-approved work. Payment in ~10–21 days with clean claims. Admin: moderate, with strong preference for eReferrals/coding accuracy.
• Vitality: Contracted rates broadly in line with AXA/Bupa for common codes; plans may include member excesses, but providers should assume no shortfalls once contracted. Payment cycles reliable (10–21 days). Admin: moderate, with wellness-centric reporting requests in some pathways.
• WPA: Often the most flexible. Under certain policies (e.g., Shared Responsibility), members pay a proportion, and WPA may allow top-ups above benefit limits. Payment timelines 7–21 days. Admin: typically lighter; check policy class carefully.

Gap fees and shortfalls:

• Self-pay: You set the fee; collect upfront or at point of care. Zero insurer rules; highest control, fastest cash.
• Insured (Bupa/AXA/Vitality): If fee-assured/approved, your price is the schedule; you cannot invoice the patient for any difference. If non-assured, the patient may face a shortfall; many policies and hospitals disincentivise this.
• Insured (WPA): Frequently allows member co-payments or top-ups; verify before confirming fee to the patient.

Net-of-admin reality:

• Self-pay at £250 collected today can out-earn an insurer £170 paid in two weeks if you spend 15–20 minutes chasing authorisations and remittances. Time is a cost.
• Denials and resubmissions: build an assumption of 1–3% revenue friction on insured work from coding disputes/eligibility errors unless your processes are tight.
• Card processing: 1.2–2.0% typical. You cannot surcharge most consumer cards in the UK; bake this into pricing.

Note: Ranges are indicative 2025/26 observations across London and large UK cities. Always check your provider agreement and codes; rules on shortfalls and top-ups vary by insurer and policy.

A 5-step pricing framework

1) Build a cost-plus floor

Calculate your fully loaded hourly cost including:

• Room/clinic rent (include VAT/service charges) and the unused time between appointments
• Clinical indemnity, GMC fees, CPD, equipment, software
• Admin staff time per appointment (phone, triage, billing) and your own non-clinical time (reports, letters)
• Marketing, website, directory listings
• Bad debt/DNAs (assume 2–5% unless deposits/cancellation policy is enforced)

Worked example (London specialist):

• Room: £60/hour; true utilisation 70% → effective £86/hour allocated to clinical hours
• Admin: 15 mins per patient at £20/hour → £5 per 15-min block; on a 50-min session ≈ £17
• Software, phone, indemnity, CPD, web: allocate £18 per session
• Card fees at 1.5% on £220 = £3.30; DNA provision 3% on fee = £6.60
• Letters/forms average 10 mins → if your clinical hour is valued at £150, that’s £25 of hidden time

All-in cost per 50–60 min is already nudging £140–£160 before paying yourself a profit. If you want a 30–40% operating margin to reinvest and de-risk, your floor price is likely £200–£240 in Central London for complex specialties. Outside London, floors closer to £140–£180 are common.

2) Anchor to the market

Build a quick competitor matrix: three consultants you genuinely compare with (same city, similar reputation), plus two stretch comparators. Capture initial/follow-up fees, wait times, and whether they publish outcomes or patient-reported measures. Anchoring is not copying; it’s setting your range with eyes open. Reference PHIN and hospital consultant pages for public benchmarks.

3) Signal value where you are differentiated

Price follows value signals. If you offer rapid access (under 7 days), integrated MDT input, structured reports within 48 hours, and outcome tracking, you can credibly sit at the upper quartile. Make the invisible visible on your website and confirmations: turnaround times, access channels, what is included. If you subspecialise (e.g., ADHD, perinatal, complex trauma, adolescent sports ortho), show pathways and data.

4) Package and reduce friction

Bundling reduces the patient’s risk and your admin friction. Convert single sessions into a clearly defined plan priced for commitment and compliance (see the next section). Pre-authorise insurer episodes when possible to avoid piecemeal approvals.

5) Review with a cadence

• Review fees every 6–12 months. Use CPI + 3–5% as a baseline in 2026, with a step-change when repositioning service level.
• Update your published fees and inform referrers. Change new-patient fees first; consider staggered increases for follow-ups.
• Monitor KPIs: enquiry-to-booking conversion, no-show rate, insurer mix, debtor days, margin per clinical hour.

Package and bundled pricing that actually converts

The objective is ethical clarity and operational efficiency: patients know what they are getting and at what price; you reduce admin and DNAs while improving continuity.

• Mental health – comprehensive assessment bundle:
  • Deliverable: pre-assessment screening pack, 75–90 min initial, one 30–45 min follow-up, GP letter within 72 hours.
  • Pricing: Central London psychiatry £550–£800 all-in; UK regions £400–£650. Make the inclusions explicit.
• ADHD/Neurodevelopmental pathway:
  • Deliverable: validated questionnaires, collateral history, 90–120 min assessment, titration plan, two follow-ups, school/employer letter.
  • Pricing: £1,100–£1,950 depending on complexity and titration support model. Consider two tiers: standard vs enhanced (with messaging support).
• Psychology therapy block:
  • Deliverable: six-session CBT course including initial formulation and end-of-block summary letter.
  • Pricing: 6 x £130 list → bundle at £720–£780 for prepayment (effective £120–£130/session). Include one flexible reschedule per block.
• Addiction or eating disorder programme:
  • Deliverable: 4-week outpatient programme, weekly psychiatry review, 2x weekly group therapy, family session, relapse plan, outcome measures.
  • Pricing: £3,000–£6,000 depending on MDT intensity; offer step-down month at £1,200–£2,000.
• Plastic surgery pre-op bundle:
  • Deliverable: initial consult, second “cooling-off” consult, pre-op nurse assessment, anaesthetist review (where applicable).
  • Pricing: £350–£600 for the pre-op pathway (creditable against surgery). Ensure compliance with GMC/CMA guidance on cosmetic interventions and cooling-off periods.
• Private GP retainers:
  • Deliverable: 12-month membership, 6 x 20-min appointments, secure messaging, repeat prescription management, annual health check.
  • Pricing: individuals £900–£1,500/year; family plans discounted. Cap message volumes and define SLAs.

Operational notes:

• Take a deposit (25–50%) or full prepayment for bundles; offer 5–10% incentive for upfront payment.
• Spell out cancellation/expiry rules and what is “included vs billable extras” (e.g., extended letters, third-party forms).
• Use software with packages, stored cards, and automated reminders; see our healthcare software selection service for a shortlist matched to UK insurer workflows.

Raising fees without losing patients

Treat pricing updates as clinical operations: planned, transparent, and patient-centred.

• Notice period: 30–60 days for existing patients; apply new rates immediately for new enquiries.
• Sequencing: move assessment fees first (where demand is strongest), then follow-ups. Alternatively, grandfather existing patients for 3–6 months.
• Segmentation: consider hardship pricing for a small quota (e.g., 5–10% of caseload) and publish eligibility quietly to avoid gaming.
• Referrers: update them early; provide a one-page summary of what is now included (e.g., faster letters) to frame value rather than “just a rise”.

Script (email):

“From 1 September 2026 our consultation fees will change to £280 for a 50-minute review and £420 for a 75-minute assessment. This reflects increased clinic and staffing costs, and our commitment to 48-hour report turnaround and same-week appointment availability. If you already have appointments booked before 1 September, the current fee will apply. If cost is a concern, please let us know; we reserve a small number of reduced-fee slots each month.”

Script (in consult):

“From next month my standard follow-up fee will be £280. That includes your GP letter within two working days and access to secure messaging for prescription queries. For you, given we started this pathway at the old rate, I’ll hold your next two appointments at £250 before moving to the new fee.”

Common pricing mistakes

• Under-pricing assessments: The first hour contains triage, risk, and formulation plus a long letter. Price it at least 30–70% above a follow-up or bundle the first follow-up.
• Ignoring no-show economics: A 5% DNA rate erodes margin by >5% if you do not pre-charge deposits and enforce a 48-hour cancellation policy.
• Flat rate across complexity: Have a standard and a complex follow-up tier (e.g., 30 vs 50 minutes) and a surcharge for urgent same-day slots.
• Accepting insurer cuts without negotiation: Evidence your outcomes, scarce subspecialty skills, and wait time to argue rates or at least secure pathway inclusion. Consider staying non-assured selectively.
• Hidden freebies: Medical-legal forms, extended clinical letters, and employer reports should have a published fee (e.g., £45–£120 depending on time).
• Not publishing fees: Patients value predictability; transparency also aligns with CMA/PHIN expectations.
• Cashflow traps: Letting insurer receivables drift beyond 30 days. Use eBilling, remittance audits, and weekly claims runs.

Frequently Asked Questions

Can I charge different self-pay and insured fees?

Yes. You can set self-pay fees independently. Once you are a recognised/fee-assured provider with an insurer (e.g., Bupa/AXA/Vitality), you agree to their schedule for insured patients and generally cannot charge a shortfall. WPA often permits top-ups under certain policies. Publish your self-pay fees and state that insured patients are charged according to their insurer’s approved rates. For more on recognition and cover, see our primer on insurance and indemnity in private practice.

Do I have to publish my fees?

Transparency is best practice and, in effect, a sector expectation. The CMA’s private healthcare market investigation and PHIN programme require publication of standard information, and many hospitals list consultants’ outpatient fees. At minimum, publish initial and follow-up fees and what is included (letters, tests not included, etc.), and ensure hospital partners have accurate data. Refer to PHIN and the CMA guidance.

How should I handle DNAs and cancellations, especially with insurers?

For self-pay, state a 48-business-hour cancellation policy and charge 100% within 24 hours (or hold a deposit). For insurers, most do not reimburse DNAs; you may charge the patient directly if your terms allow and they used a consumer card (mind surcharge rules). Communicate the policy at booking and in reminders. Automate payment collection to reduce awkwardness.

How often should I review my fees, and by how much?

Every 6–12 months. Baseline: CPI plus 3–5% to account for wage/room inflation and to fund service improvements. Adjust more aggressively if you have clear differentiation (e.g., outcomes, access, subspecialty). Change new-patient fees first; legacy follow-ups can be stepped.

Can I add a card surcharge to cover fees?

No, not for consumer cards. UK regulations prohibit surcharging most consumer card payments. Treat processing costs as part of overhead and price accordingly. If you take business or international cards with higher fees, absorb or set your base price to cover the blended rate.

Final thought and next steps

Pricing is a clinical governance issue in disguise. It sets your capacity to deliver safe access, timely letters, and proper follow-up. If you want an external operator’s view on your numbers, packages, and insurer mix, our practice optimisation service will build your cost model, redesign your pricing, and implement the systems (billing, eClaims, deposits) to make it stick. If software is part of the bottleneck, we can also help with clinical and billing software selection. And if you are just starting, our breakdown of private practice setup costs and our guide to maximising private practice revenue will accelerate your first 90 days.

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