Two Speeds of Medicine: The Rise of the Pay-to-See-Sooner Culture and Where That Leaves Everyone Else

There was a time when the phrase 'going private' carried a certain connotation — a choice of the wealthy, or a perk of employer health insurance. That time has passed. Walk into many NHS outpatient departments today and you will find patients who have already paid for their own MRI scan, funded a private consultation to jump a gastroenterology queue, or bought a course of physiotherapy that the NHS could not provide for eight months. Some were told about these options by their own GP.

This is the new reality of British healthcare: a two-speed system operating within a single one, and it raises uncomfortable questions that Doctors for Patients UK believes deserve honest discussion.

The Numbers Behind the Quiet Shift

Private healthcare in the UK has grown steadily since the pandemic, when waiting lists ballooned past seven million. Self-pay hospital admissions, diagnostic scans and private GP appointments have all risen sharply. Industry analysts note that a growing share of private patients are not insurance-covered executives but ordinary households — retirees remortgaging for a hip replacement, parents crowdfunding an ADHD assessment, workers spending a month's salary on an MRI to shortcut a 40-week wait.

Perhaps most strikingly, research and professional surveys suggest a meaningful proportion of GPs have at times suggested patients consider paying privately for diagnostics or specialist input when NHS waits are extreme. Guidance from the GMC permits doctors to raise private options, provided they do so without pressure and continue to offer NHS care. But patient groups report a murkier reality: consultations where 'you could always go private' lands not as neutral information but as the only realistic route to being seen.

Is Two-Tier Care Becoming Normalised?

Defenders of the status quo argue that private spending relieves pressure on the NHS — every self-funded scan is one fewer on the public waiting list. Critics counter that this is precisely how a universal system begins to fray: capacity drifts towards those who can pay, waiting times lengthen for everyone else, and the moral bargain of the NHS — care free at the point of need — erodes one credit card transaction at a time.

There is also a clinical dimension. A patient who pays for a private scan but returns to an NHS GP with the results may find the report isn't automatically visible to their NHS record. Follow-up may be fragmented. Private diagnoses can arrive without the wraparound care that made them meaningful. Paying speeds up the test; it does not always speed up the treatment.

For the majority who cannot pay, the risk is subtler but real: a quiet cultural shift in which long waits come to be seen as normal, and escalation as pushy. We want to push back firmly against that idea. Waiting passively is not politeness; it is a rights issue.

What You Can Do Without Spending a Penny

If you cannot afford private care — and most cannot — the law and NHS constitution still offer you genuine leverage:

• Ask for your waiting time to be clinically reviewed. If your condition has worsened, request that your position on the waiting list be reassessed. Deterioration can move you up legitimately.
• Invoke your right to choose. Under the NHS Choice Framework, you can ask to be treated by any provider — including other trusts or independent-sector providers delivering NHS care — with shorter waits. Ask your GP for a referral to the provider with the shortest queue.
• Ask whether you meet criteria for a Reviewed Patient Initiated Follow-Up or whether your appointment can be re-triaged to an urgent pathway. Many trusts have clinical triage systems patients never hear about unless they ask.
• Escalate in writing. A polite, dated letter to the hospital's patient advice and liaison service (PALS) or the waiting list manager, describing symptom progression, creates a record and prompts review.
• Use the NHS app and written queries to keep everything documented — and complain formally through the trust's complaints procedure if deadlines are breached.

A System Worth Defending

We do not blame individual patients for paying when they can; nor do we blame GPs working under impossible constraints. But a healthcare settlement should not depend on the depth of a family's savings. The more patients escalate within the NHS — using choice, clinical review and formal complaint — the stronger the signal that long waits are unacceptable, and the harder it becomes for two-tier normalisation to set in.

Your health is not a luxury item. Neither is your place in the queue.