How do I manage patient expectations in a private setting?

Where expectations come from

Patients who pay usually come with a clear idea of what they are buying: quick access, unhurried time, and a doctor who will get things done. Most of the time you can deliver that. Problems arise where the patient’s picture differs from yours, most often about money, speed, tests, prescriptions and what happens next in the NHS.

The fix is mostly administrative. Say it in writing before the appointment, repeat it in the consultation, and record what you agreed.

Before the first appointment

In England, regulation 19 of the Care Quality Commission (Registration) Regulations 2009 requires registered providers whose patients pay for their care to give them a written statement of terms and conditions, including the amount and method of payment of fees. Where reasonably practicable, this must be given before the service starts. In Wales, Scotland and Northern Ireland, independent clinics answer to Healthcare Inspectorate Wales, Healthcare Improvement Scotland or the RQIA instead, so check their requirements on patient information. Your terms should cover:

• What the fee covers. Length of appointment, and whether it includes a follow-up, test results or a letter.
• What costs extra. Blood tests, specialist referral letters, reports, prescriptions and repeat prescriptions.
• Cancellation and missed appointments. Your policy and any charge.
• Access. How to contact you, response times, and what to do when you are closed.
• Your relationship with the NHS. That you will ask to share a summary with their NHS GP, and why.

Consumer law also expects the total price to be shown up front. The CMA’s price transparency guidance explains the ban on drip pricing, where unavoidable charges are only revealed later in the purchase.

Access and speed

Quick access is often why patients choose you, so be precise about it. "Same-day appointments" should mean what it says, or be qualified. Tell patients how long results usually take, and who will contact them. If you work part time, say so, and explain who covers when you are away. See giving patients your phone number.

When a patient asks for something you do not recommend

Private patients sometimes arrive with a request: a scan, a set of blood tests, antibiotics, or a particular medicine they have read about. Payment does not change your duty. GMC guidance on decision making and consent says that if a patient asks for treatment or care you do not think is in their clinical interests, you should explore their reasons, their understanding and their expectations. If you still think it would not serve their needs, you should not provide it. Explain why, discuss other options, and tell them about their right to a second opinion.

A few practical habits help:

1. Ask early what the patient hopes to leave with. It is easier to discuss than to refuse at the end.
2. Explain the downside of unnecessary tests, including false positives and further investigation.
3. Offer what you can do, such as a plan to review, a safety-net or a referral.
4. Record the request, your reasoning and what you agreed.

Consider offering a partial or full refund where the patient came for something you will not provide. It avoids the impression that you are being paid to refuse. See informed consent in private practice.

What the NHS GP will and will not do

This is the expectation most likely to cause problems later. Many patients assume their NHS GP will continue whatever you start. BMA guidance for NHS practices says the opposite:

• A GP should only arrange investigations and prescribe where it is necessary for the GP’s own care of the patient.
• Private providers should arrange and act on the tests they order. The patient pays for them.
• Shared care with private providers is not recommended, and all shared care is voluntary.

Before you start a long-term medicine or a monitoring plan, tell the patient that you, not the NHS GP, will usually be responsible for continuing it, and what that will cost. If you hope the NHS GP will take it on, ask them first. See communicating with NHS GPs.

Insurance and referrals

Many patients assume private medical insurance will cover a private GP appointment. Many policies do not, although some include their own remote GP service. Some insurers also require their own referral route to a specialist. Tell patients to check with their insurer before booking or before you refer. See can patients pay with insurance?

When expectations are not met

If a patient is unhappy, go back to what was agreed in writing. Often the fix is an apology and a clearer explanation, sometimes a refund. Record it, and change your terms or booking information if the same misunderstanding keeps happening. If it becomes a formal complaint, follow your procedure. See managing complaints.