Established practice
You're recognised by all the major insurers, but PMI patients are choosing your competitors
Recognition isn't the same as preference. The hospitals winning PMI patient volume have clinical outcomes data, verified reviews, and a digital presence that gives patients confidence before they choose. Most don't.
- steps
- 8
- steps
- to start
- 1 week
- to start
The short answer
Insured admissions reached about 670,300 in 2025, up about 1%, then fell 2.6% in Q1 2026 (PHIN), while spending on private medical cover kept rising. Insurers increasingly steer members through their own pathways, consultant lists and hospital lists, so if your site or your consultants are not on the lists insurers use, patients are routed elsewhere before they ever search for you. Solve it by comparing your insured trend with the market, checking where you sit on each major insurer's lists and pathways, closing consultant gaps, and making it easy for insurer case managers to book with you.
8 steps
Do it yourself: step by step
0 of 8 done
Plot your insured admissions by quarter for three years against PHIN's published UK and regional trend. Break yours down by insurer and specialty.
- Time
- 1 week
- Typical cost
- Staff time only
- Who does it
- Commercial lead with finance
Done when: You know which insurers and specialties are flat or falling faster than the market
This problem is Solvable.
Copy this table
PMI volume diagnostic and insurer visibility grid
Free to copy, adapt and use. No sign-up.
PMI volume diagnostic
Fill one row per insurer, then one row per top specialty. Look for where the market grows and you do not.
By insurer
| Insurer | Admissions 3 years ago | Admissions last 12 months | Change % | Hospital list status | Guided pathway status | Account manager view |
|---|---|---|---|---|---|---|
| Bupa | ||||||
| AXA Health | ||||||
| Aviva | ||||||
| Vitality | ||||||
| WPA | ||||||
| Other |
By specialty
| Specialty | Recognised consultants | PMI cases last 12 months | Change % | Share by top consultant % | Next available outpatient date | Gap? |
|---|---|---|---|---|---|---|
| [Orthopaedics] | ||||||
| [General surgery] | ||||||
| [Ophthalmology] | ||||||
| [Gastroenterology] | ||||||
| [Urology] |
Reading the table
- Falling with one insurer only: commercial or listing issue. Start with the contract.
- Falling in one specialty across insurers: consultant capacity or recognition. Start with the consultant grid below.
- Falling everywhere: enquiry handling or GP referral links. Start with the booking pathway.
- One consultant above 50% of a specialty: concentration risk if they retire or move.
Insurer visibility grid
One row per consultant. Update quarterly. Check each insurer's current product and list names before you use the grid; they change.
| Consultant | Specialty | Bupa recognised | Bupa guided or open referral list | AXA Health recognised | AXA Health guided list | Aviva recognised | Aviva network list | Vitality recognised | WPA recognised | Fee-limited anywhere | Action needed | Owner | Due |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| [Name] | [Specialty] | [Y/N] | [Y/N] | [Y/N] | [Y/N] | [Y/N] | [Y/N] | [Y/N] | [Y/N] | [which] | [action] | [owner] | [date] |
Monthly note to insurer case managers
Subject: [Hospital name] availability, [month]
Dear [Name],
Below are our current waits for first outpatient appointments and surgery. Please call [direct number] to book any of your members.
| Specialty | First outpatient (days) | Surgery from decision (weeks) | Consultants |
|---|---|---|---|
| [Orthopaedics] | [x] | [x] | [names] |
| [Ophthalmology] | [x] | [x] | [names] |
Kind regards, [Name], [Role], [Hospital name]
Avoid these
Common mistakes
- Blaming marketing before checking whether insurers have moved their members elsewhere.
- Assuming the hospital contract makes every consultant visible to insurer members.
- Not knowing which insurer pathways steer patients away from you.
- Relying on one or two consultants for most of a specialty's insured work.
- Recruiting a consultant without allowing for the time insurer recognition takes.
- Never speaking to the insurer case managers who book members directly.
- Hiding insurer information deep in the website.
- Comparing yourself with last year instead of with the market trend.
Free personal check
Done by Paul Robinson, not software
I'll check how your hospital and consultants appear on the main insurers' finder tools
What I need from you
- Hospital name and town
- Website address
- Your three main specialties
What you get
- Screenshots from insurer finder tools and Google
- Gaps in your insurer listings and consultant status
- The three changes that matter most
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
About 670,300 insured admissions in 2025, up about 1% on 2024, with the insured to self-pay split at 70:30
Most private activity runs through insurer rules on who patients can see, and insured volume grew only slightly
Insured admissions fell 2.6% in Q1 2026 against Q1 2025, while self-pay rose 7.7%
The insured market has stalled, so growth has to come from winning share
Private medical cover revenues rose 10% in 2024
Insurance spending is rising faster than insured admissions
Paul Robinson
14 years in UK private healthcare
I solve this one for hospitals
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
If more people have insurance, why are we not busier?
Insurers increasingly direct members to a short list of hospitals and consultants, and consultants follow sessions and support. Growth goes to hospitals on the right lists with the right consultants.
How do insurers steer patients?
Through products that offer a list of consultants or sites, guided referral options, and case managers who suggest hospitals and consultants. Details vary by insurer and policy.
Can we pay insurers to list us higher?
Not in the way you would buy advertising. Insurer hospital lists and guided pathways are set through contracts, which weigh price, quality and access. Your levers are the commercial negotiation and your consultants' recognition.
Can we ask an insurer for our referral data?
Yes. Account managers will often share your volumes and sometimes local market context. Ask in writing before the contract review.
Can the hospital apply for recognition on behalf of consultants?
No. Consultants apply for insurer recognition themselves. The hospital can help with paperwork and timing.
Do we have to push consultants onto fee-limited lists?
No, and you should not pressure fees. Explain the trade-off and let them decide.
How long does a new consultant take to bring insured work?
Practising privileges can take one to three months. Insurer recognition can take a similar time again, and building a referral base takes a year or more (Solvable estimates).
How often do insurer pathways change?
Insurers update products and lists from time to time, often at policy renewal. Review your grid quarterly.
Insurers list you but patients still choose competitors?
See: You are recognised by insurers but PMI patients are not choosing you
Looking for help with the insurer negotiation itself?
See: Insurer contract negotiations are not going your way
Last reviewed:
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