Finding your way through the clinics.

How do clinics, pharmacies and producers fit together?

They're three separate things, even when they share a logo, and it helps to know which is which. The clinic employs the doctors and nurses who assess you and decide. The pharmacy, which is licensed to handle these medicines, fills the prescription and posts it. The producer or importer makes or brings in the product. Some companies own all three; many don't. When something goes wrong it's usually at a join between them, so knowing which bit you're dealing with saves a lot of frustration.

Choosing a clinic

Start with the specialty. Clinics tend to be strongest in the areas their consultants come from, so it's worth asking which specialties a clinic's doctors work in. Check the clinic is registered with the healthcare regulator for the country it operates in: the Care Quality Commission in England, Healthcare Improvement Scotland in Scotland, Healthcare Inspectorate Wales in Wales. Every legitimate clinic is, and they'll say so.

Then ask the questions that tell you how the clinic is run. Who screens me before I see a doctor, and are they a clinician? Does a team review the decision before a prescription is written? Who will I speak to after I start, and how quickly can I reach them? What happens if my product goes out of stock? A clinic that can answer those easily has thought about them.

Reviews are worth reading with a pinch of salt in both directions. Patients who did well write warmly and patients who didn't often blame the wrong part of the system.

To make this easier, use my free Questions to ask any clinic checklist, or download the printable version (PDF, 2 pages). Take it to a first appointment, or use it to compare clinics side by side.

What does it cost?

There's a consultation fee, cheaper follow-ups, and a monthly cost for the medicine. Prices change and I won't pretend to know every clinic's, but that shape is consistent. Some clinics charge for the screening or the multidisciplinary review separately, so ask for the total to first prescription. Follow-up consultations happen every few weeks at first, then less often. The medicine is the main ongoing cost, and it depends entirely on what you're prescribed and how much; ask for a realistic monthly figure for the plan the doctor proposes, not the cheapest product on the list. Some clinics offer subscription models or access schemes that lower the cost in exchange for sharing your outcome data. Nothing is covered by the NHS for the vast majority of patients.

How long does it take?

In my experience, it takes two to four weeks from first contact to the medicine arriving, if one is prescribed and your records come promptly. The waits are for your GP records, for the team review, and for the pharmacy to source the product. The consultation itself is usually available quickly. If a clinic promises a prescription within days, it's worth asking how the steps above fit in.

The pharmacy

Once a prescription is written, the pharmacy will contact you to take payment and arrange delivery, usually by tracked, signed-for post. Stock varies, so if a product is unavailable the pharmacy or clinic will usually suggest an alternative. Keep everything in its original packaging with the label on: it's your proof of a legal prescription, and you'll want it for driving, work and travel. Repeat prescriptions normally come through the clinic at your follow-up, so don't wait until you've run out to ask.

Can I change clinic?

Yes, you can. Ask your current clinic for your records and a summary of your treatment, and the new clinic will take it from there. It's more common than you might think, and clinics are used to it.

When it doesn't feel right

If you're worried about side effects, contact the clinic first, and your GP or NHS 111 if you can't reach them or you feel unwell. If you're unhappy with how a clinic has treated you, every registered clinic must have a complaints process, and the regulator wants to hear about the ones that don't work.