Fees get set at the start, based on what nearby practices charge and what feels defensible. Then they stay. Costs rise, the currency moves, salaries increase, and the fee stays where it was because raising it feels like a confrontation with patients.
The result is a practice working harder each year for less.
Know what a consultation costs you
Very few small practices can state this. It is not complicated to work out: total monthly running cost, including your own time at a realistic value, divided by the number of patient encounters in a month. That figure is the floor. Anything below it is subsidised by you.
Doing this once is often uncomfortable and always clarifying, particularly for services people assume are profitable.
Look at services individually
Practices tend to think about the consultation fee and neglect everything else. A procedure that takes a room, consumables and a clinician for an hour may be priced as though it were a short review. Cross-subsidy is a legitimate choice, but it should be a choice rather than an accident.
HMO rates are a separate calculation
Your HMO reimbursement is negotiated, often below your private rate, and paid late. Know what proportion of your work is HMO, at what rate, with what delay. A practice whose HMO mix has quietly grown may be busier and worse off, and it will not show up in patient numbers.
Review on a schedule
The reason fees go unreviewed is that no date exists for reviewing them. Put one in: annually, at the same point each year, alongside your other planning. Reviewing does not commit you to raising. It commits you to looking.
Adjust in smaller steps
A practice that has not moved its fees in four years faces a large correction, which is exactly the kind that patients notice and object to. Smaller, regular adjustments are absorbed more easily and keep you closer to your actual costs.
Communicate it plainly
When fees change, say so before patients discover it at the desk. A short notice at reception and on the website, a few weeks ahead, stating what is changing and from when. No apology and no lengthy justification. Patients accept price changes from businesses they trust; what they object to is surprise.
Publish something
Practices that publish no prices at all lose the patients who would have paid but were not willing to phone to find out. Publishing a starting figure or a range, with a clear note that HMO cover changes what an individual pays, answers enough to keep people engaged.
If you use our practice systems, your fee schedule should live in one place that both the front desk and any quote or invoice draws from, so that a change is made once rather than in four places that will eventually disagree.