Going private: what you are actually buying

What the wait actually costs

The case for paying is usually framed as convenience. The evidence frames it as harm.

Longer waits for elective procedures in England produce measurably larger health losses than shorter ones, and the losses fall hardest on people in more deprived areas.¹ A prospective observational study specifically in elective urological surgery found that delay produced both physical complaints and psychological distress.² The psychological burden of waiting is itself well described, and is not merely impatience.³

Waiting is also not a stable state. A substantial number of patients on elective waiting lists in England are admitted as emergencies while still waiting.⁴ In men waiting for prostate surgery, prolonged urinary retention while on the list drives up both complications and cost, and the authors of that analysis argue directly for earlier intervention on those grounds.⁵⁶

For urological cancer, the direction is the same: delay between diagnosis and surgery worsens quality of life and anxiety, and the pandemic backlog reinforced the case for expediting rather than deferring.⁷⁸

None of this means everyone should pay. It means the thing you are buying — time — is not cosmetic.

What you are not buying

Being straight about this matters more than the sales pitch.

You are generally not buying better surgery. Reviews of private provision in high-income countries find mixed results on accessibility, safety, clinical effectiveness and cost-effectiveness rather than uniform superiority.⁹¹⁰ NHS-funded work carried out in the independent sector delivers equivalent quality for high-volume, low-complexity care.¹¹ Many of the same consultants operate in both systems; I do.

And there is a real caution in the literature about who owns the provider. A BMJ systematic review of private equity ownership in healthcare found it associated with increased costs to patients or payers, and mixed-to-harmful effects on quality, with no consistently beneficial impact.¹² That is a reason to ask who owns the hospital you are being booked into, not a reason to avoid private care altogether.

Where the bill actually grows

The consultation is the cheap part. Nearly every complaint I hear about private cost is about what came after it.

My own fees are published: £295 for a first consultation and £190 for follow-up. The items that move the total are the diagnostics and the procedure — imaging, cystoscopy, biopsy, theatre time and anaesthetics — and these vary widely between providers and change over time, which is precisely why a number quoted on a website is worth less than one quoted to you in writing.

So the single most useful thing you can do before booking is ask for an all-in written estimate that covers the likely pathway, not just the appointment:

• What tests are likely at the first visit, and what do they cost on the day?
• If imaging or a camera test is needed, what is the total including the reporting fee?
• If this turns out to need surgery, what is the quoted package, and what is excluded — anaesthetist, implant, overnight stay, follow-up?
• What happens to the price if there is a complication?

A clinic that will not put that in writing has told you something.

Insurance, and the parts it usually will not cover

Insurers generally cover acute, medically necessary problems, and generally exclude the things people most often want privately: fertility treatment, vasectomy, circumcision by preference, and screening in the absence of symptoms. Most policies also cap outpatient diagnostics, which is where urology bills concentrate.

Two practical points. Most insurers want a GP referral letter even where the clinic accepts self-referral, so get one before you book if you intend to claim. And ring the insurer with the procedure code rather than the procedure name — authorisation is granted against codes.

Can you diagnose privately and treat on the NHS?

Often, yes — and it is a legitimate route rather than a loophole. In practice it works when the NHS team accepts the work-up, which is more likely if you bring the full report, the actual images rather than a summary, and any histology.

Be aware it is not guaranteed. Some units repeat imaging to their own protocols, and private referrals have genuinely complex effects on NHS pathways — including on the waiting lists of people who did not pay.¹³ I mention that because it is true, not to discourage you.

The honest caveat about the whole arrangement: access to private care is not evenly distributed. Waiting times already differ by socioeconomic status, with up to a 35% difference between the most and least deprived groups in one analysis, and only a small fraction of that explained by patient choice.¹⁴ Private provision is concentrated in some regions and thin in others, and the pattern in England has been described as an emerging two-tier system.¹⁵¹⁶ Paying moves you up a queue; it does not shorten the queue.

What to ask before you book

Three questions that save the most money and disappointment:

1. What is the realistic all-in cost of this pathway, in writing? Not the consultation fee.
2. Will you send everything to my GP, and will your work-up transfer if I go back to the NHS for treatment?
3. Who do I call, and who takes responsibility, if something goes wrong at two in the morning?

That last one distinguishes a consultant practice from a booking platform, and it is worth more than the difference in consultation fee.

When not to book privately at all

Some things should not wait for an appointment, private or otherwise. Go to an emergency department if you cannot pass urine at all, if you have stone pain with a fever, or if you have heavy visible blood with clots.

Paying for a slot next week is the wrong response to a problem that needs a catheter or a drain today.

Worth reading alongside: am I wasting the doctor's time?, and what happens at a first appointment.