How should I collect payment for private GP appointments?

When to take payment

Many private GPs used to post invoices after clinic and then spend hours chasing them. Many practices now take payment before or at the appointment instead. The main options:

Approach	Works well for	Watch out for
Full payment at online booking	Standard consultations with a fixed price	Needs clear cancellation and refund terms
Deposit at booking, balance on the day	Longer or higher-value appointments	Two transactions to reconcile
Card details at booking, charged after	Services where the final price varies	Patients must agree clearly to when and why the card will be charged
Payment at the end of the appointment	Adding tests or items decided in the consultation	Needs a card terminal or payment link, and a moment to take payment
Invoice afterwards	Employers, insurers with a guarantee of payment, agreed accounts	Aged debt and chasing

A common pattern is to take the consultation fee at booking, then take payment for anything extra, such as blood tests or an ECG, before the patient leaves. See charging for tests.

Why upfront payment helps

• Less admin. Nobody raises, posts and chases invoices.
• Fewer missed appointments. A patient who has paid has a reason to attend or cancel in time, and if they do not, your cancellation terms apply.
• Better cash flow. Money arrives before the costs of the session, not weeks after.
• Clearer expectations. The patient knows the price before they come, which the GMC expects anyway.

Ways patients can pay

• Online checkout at booking. A booking system linked to a payment processor such as Stripe takes the fee as the patient books.
• Card terminal in clinic for payment on the day, including contactless and mobile wallets.
• Payment links sent by text or email for extras or remote appointments.
• Bank transfer for corporate or insurer accounts.

Use a card processor so that you never store card numbers in your notes, emails or spreadsheets. Do not add a surcharge for paying by card. Card surcharges on consumer payments have been banned in the UK since January 2018.

Terms, cancellations and refunds

Write your payment terms down and show them before the patient pays. Cover:

• what the fee includes and what costs extra
• how much notice a patient must give to cancel or rebook, and what happens to their payment
• what happens if they do not attend or arrive late
• how and when refunds are made, including if you cancel.

Two points of consumer law matter for online bookings:

• Cancellation rights. A service booked online or by phone is usually a distance contract under the Consumer Contracts Regulations 2013, with a 14-day cancellation period. You may only start the service within that period if the patient expressly asks you to. If they then cancel within the period, they pay for the part of the service already provided. Once the service is fully provided, with their acknowledgement that the right then ends, they can no longer cancel. Build this request and acknowledgement into your booking flow.
• Fairness. Under the Consumer Rights Act 2015, an unfair term is not binding on the patient. A cancellation charge should reflect your actual loss, not act as a penalty.

Take advice on your booking terms if you are unsure. See managing patient expectations.

Insured and sponsored patients

Most UK health insurance does not pay private GPs directly, so ask insured patients to pay you and claim back. Only invoice an insurer or embassy if you hold a written guarantee of payment before the appointment. See can patients pay with insurance?

Managing cash flow

Private income is uneven. Bookings dip in August and over Christmas, while rent, staff and software cost the same every month.

1. Link payments to your accounts. Connect your payment processor and practice system to accounting software such as Xero, so every payment matches an invoice and the fees your processor deducts are recorded.
2. Review monthly. Compare income, bookings and costs with your business plan forecast, and spot a drop early.
3. Keep a reserve. Aim for a buffer that covers several months of fixed costs, so a quiet month does not become a crisis.
4. Set tax aside. Move a share of every payment into a separate account. Self Assessment payments on account can make the first bill much larger than expected. See tax for private GPs.
5. Chase what is owed promptly. Send reminders at set intervals and decide in advance when you will stop booking a patient who has not paid.

Records

Give every patient an itemised receipt or invoice. Keep payment records with your accounts, not in the clinical record, and keep them for at least as long as HMRC requires. If you do any VAT-able work, such as medicals, invoice it separately. See VAT for private GPs.