A GP refers a patient to you. The insurer sends them somewhere else. Here's what you can do.
Open referral and directional policies let insurers steer insured patients to consultants on their preferred lists. You can't stop the policies, but you can stop losing patients you could have kept.
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- steps
- 7
- steps
- to start
- 2 to 3 hours, plus waiting for call-backs
- to start
The short answer
Guided and open referral policies let insurers offer patients a shortlist instead of the consultant the GP named. You cannot change the policy, but you can make sure you are on the shortlists that matter, and that GPs and patients know how to ask for you by name. Most lost patients are lost at the phone call to the insurer, so that is where to focus.
What good looks like
Where you stand, before and after
On every insurer list worth being on
- Referrers name you properly
- Patients ask for you by name
Illustrative sample, not a real person or result.
7 steps
Do it yourself: step by step
0 of 7 done
Log in to each insurer's consultant or provider portal (or call the provider recognition team) and record: recognised yes or no, which networks or guided lists you sit on, which hospitals you are listed at, and whether you are on their fee schedule. Do Bupa, AXA Health, Aviva, Vitality, WPA and any others your patients use.
- Time
- 2 to 3 hours, plus waiting for call-backs
- Typical cost
- Free
- Who does it
- You or your secretary
Done when: You have a one-page table showing each insurer, your status and the list you are on
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Insurer status tracker and patient script
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Insurer status tracker
| Insurer | Recognised? | Guided or network list I am on | Hospitals listed | On fee schedule? | Lost referrals last 3 months | Action | Date checked |
|---|---|---|---|---|---|---|---|
| Bupa | |||||||
| AXA Health | |||||||
| Aviva | |||||||
| Vitality | |||||||
| WPA | |||||||
| [Other] |
Questions to ask each insurer's provider team
- Am I recognised, and at which hospitals am I listed?
- Which of your policies use a guided or shortlisted consultant list?
- Am I on that list? If not, what would I need to agree to join?
- If a GP names me and the patient asks for me, can the patient be authorised to see me under a guided policy?
- Who do I contact if my details on your search tool are wrong?
Note to GP practices
Dear Dr [Name],
Thank you for your referrals to me at [Hospital].
Some insured patients are now offered a shortlist when they call their insurer. If you would like them to see me, it helps if the referral letter names me, my specialty and [Hospital], and if the patient gives my name when they call for authorisation.
I am currently recognised by [list insurers]. My secretary [Name] can be reached on [phone] if a patient has trouble.
With thanks, [Name], Consultant [Specialty]
Secretary script for redirected patients
"I'm sorry your insurer gave you other names. Can I ask which insurer and which policy you have? [Check tracker.] Dr [Name] is [on / not on] their list for your policy. You can ask them to authorise an appointment with Dr [Name] by name. If they cannot, Dr [Name]'s self-pay first appointment is £[fee], and that includes [what is included]. Would you like me to hold a slot while you check?"
Avoid these
Common mistakes
- Assuming recognition by an insurer means you are on its guided or shortlisted lists. They are separate.
- Never checking how you appear on the insurer's own consultant search tool, where wrong hospitals or specialties quietly lose patients.
- Telling GPs to refer to you without telling the patient to ask the insurer for you by name.
- Refusing every network on principle without working out the volume you are giving up.
- Letting the secretary end the call when a patient says the insurer sent them elsewhere, with no self-pay option offered.
Free personal check
Done by Paul Robinson, not software
I'll look at where insured patients drop off before they reach you
What I need from you
- Your answers to 7 quick questions
- Your top three insurers
What you get
- Where insured patients are being lost
- Which guided lists to look at
- A short brief for GPs and patients
Within 2 working days
No sign-in, no sales call. I read every request myself and reply on WhatsApp.
Free tools
Check where you stand
Benchmarks
69% insured and 31% self-pay
Funding split of private admissions in Q1 2026, so insured work still dominates and insurer lists still matter
Source: PHIN private market update
Insured admissions down 2.6% year on year
Q1 2026 compared with Q1 2025, while self-pay admissions rose 7.7% to their highest recorded level
Source: PHIN private market update
1 to 3 insured referrals a month lost to redirection
Solvable estimate for an established consultant not on a major insurer's guided list. Count your own redirected patients for a month to check
Solvable estimate
Paul Robinson
14 years in UK private healthcare
I solve this one for consultants
Want a hand? I'll look at your situation and tell you the three things I'd tackle first.
A few quick questions, about two minutes. I read every one myself and usually reply the same day.
No sales call unless you ask for one. Just a straight answer from me.
I reply personally, usually the same day.
Questions
Frequently asked questions
Is it legal for an insurer to send my patient to someone else?
Yes, if the patient bought a policy with a guided or open referral option. They usually accept it for a lower premium. The question is whether you are on the list.
Can a patient insist on seeing me?
Under a guided policy they can usually choose from the list. If you are not on it, they may have to self-fund or accept a shortfall. Policies vary, so the patient should ask their insurer directly.
Do I have to accept lower fees to get on the lists?
Usually yes. Insurers use their fee schedules as the price of entry. Work out whether the extra volume covers the lower fee before you decide, and decide on your own: agreeing with other consultants to join or boycott a list risks breaching competition law.
What does the CMA say about this?
The CMA's 2014 private healthcare market investigation looked at insurers and consultants. The Order it produced does not regulate guided or open referral policies; network terms are a contract matter between you and each insurer. The Order does require consultants to give fee information to PHIN and to patients, so patients can compare. This is general information, not legal advice. If you think an insurer's terms are unfair, speak to a competition lawyer before acting, and do not coordinate your response with other consultants.
How do I know which policy a patient has?
Ask. Your secretary should note insurer and policy type on every insured enquiry. Patients often know the name of the option on their membership card or app.
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