Consultations at the Priory

I am a Consultant Psychiatrist at The Priory Hospital North London where I see private and some NHS patients. The hospital was designed by John Nash and, in my opinion, is the most beautiful psychiatric hospital in the world.

Private consultations and treatment

Appointments for a private assessment at the Priory North London can be made by telephoning from 9.15 to 5pm my secretary, Wendy McQueen, on 020 8920 5611 (direct line) or 020 8882 8191 (hospital). E: WendyMcqueen@priorygroup.com , Fax: 020 8447 8138. I am usually available for consultations on Wednesdays and Fridays. I can in certain circumstances arrange to do a consultation over Skype (e.g. if you are virtually housebound or live very far away).

Private consultations may be paid for either personally or by a health insurer. A third party such as a relative or solicitor may also fund a consultation but only if it has been pre-authorised in writing.

For private consultations, it is preferable to have a referral from your general practitioner, therapist or consultant. This is NOT necessary if, for example, you do not have a GP or do not wish your GP to be involved. However if you wish to claim the fees from your health insurer, they will usually require you to be referred by your GP. If you need to take medication, I am reluctant to prescribe without your GP knowing what you are taking. I usually have a waiting list of about 3-4 weeks to see private patients but will endeavor to see you the same or next day if you are likely to need admission to hospital (for example if you are suicidal). I do not see patients at weekends. However, I start at 8.30am and see one new patient at 6pm on Wednesday evenings each week.

Fees

I charge £320 for an initial assessment. This includes a written summary and any recommendations. Follow up appointments are £130 (for half an hour), £200 (for 3/4 hour) and £240 (for an hour). These fees are normally recoverable under medical insurance (e.g. BUPA, AXA PPP, Norwich Union, Standard Life, Simply Health) if you have been referred by your GP and it has been pre-authorised. My terms will be sent or emailed to you when an appointment is confirmed. Appointments can be done over Skype if you can complete various questionnaires beforehand and return to me before the consultation. Fees for home visits are higher and reflect my travelling time.

I am able to see patients at The Priory on the NHS in certain circumstances with funding pre-authorised from your local Clinical Commissioning Group or local Health Board in Wales and Scotland (for example if assessing suitability for a possible admission to the Priory) or if it is part of the Highly Specialist Service for severe treatment refractory OCD or BDD (see below). In such circumstances, you need to be referred by your local Consultant or care coordinator with information about your problem and past treatments.

What to expect

For an initial consultation, my secretary will email or send you some questionnaires to complete beforehand. This provides me with a comprehensive picture of your background and information on your problem. I will gain further information during our consultation and usually come to a diagnosis and some understanding with you about the development and what is keeping your problem going. At this stage I am providing an overview. Occasionally I might recommend some investigations. This will then lead to a discussion of treatment options and the advantages and disadvantages of each. Usually there is a choice of cognitive behaviour therapy or medication or a combination of the two. In severe cases, there is the option of in-patient or day-patient care on a more intensive program at The Priory North London. For therapy, I will usually recommend a colleague as I have a limited capacity in my private practice. For example, I am only at the Priory on two days a week and one evening and busy with in-patients or day-patients.

Lastly, I may provide or recommend some reading. I prefer to see an individual alone first and then if requested see the person’s partner or relatives. Our consultation will normally last about an hour to an hour and a quarter depending on the complexity of the problem. I will then provide a written summary of our assessment and recommendations which can be sent to your GP, Consultant or therapist with a copy to you. You may also withhold consent for a report to be sent to anyone.

Consulting Rooms

The Priory Hospital North London
Grovelands House
Southgate
London N14 6RA

Click here for directions to The Priory Hospital North London on a “Bing” map or  here for a local map or  download written directions.

I can very occasionally see patients in Muswell Hill, N10. I do not see private patents at the Maudsley or Bethlem Royal Hopitals.

Telephone or Skype/ Facetime

If you are housebound or live very far away, then it may be possible to do an initial assessment over the telephone or by Skype, if you can complete the questionnaires beforehand and return them to me beforehand.

Children & Adolescents

I am not a specialist in Child and Adolescent Psychiatry but I do assess adolescents who suffer from my specialties in OCD, BDD or a Specific Phobia of Vomiting. For children under the age the 12 or for adolescents who have complex problems such as ASD, I would initially recommend an assessment with my colleague Dr. Bruce Clark and his team who see NHS patients at the Young Person’s  OCD and BDD clinic at the Maudsley Hospital in London.

I admit young people with severe OCD or BDD to our Adolescent units who have not been able to make progress as an out-patient (both NHS and private). For the NHS route, you would need to be referred by a Consultant Child and Adolescent Psychiatrist on the NHS or preferably by Dr. Clark’s team (see below).

For a private assessment of children under 12, you might like to see first my Consultant Child and Adolescent colleague Dr Trudi Roussow, who shares the same secretary with me.

Treatment programmes for OCD and BDD or depression

The Priory Hospital North London offers intensive treatment programmes for adolescents or adults with Obsessive Compulsive Disorder (OCD) or Body Dysmorphic Disorder (BDD) or other anxiety disorders or depression as an in-patient or day-patient. Out-patients are normally seen by a recommended colleague, who may be closer to your home or work.

In-patient services at the Priory

The hospital is located in a secluded part of Southgate, north London and set in several acres of private grounds. Individuals with OCD or BDD are normally admitted when they have failed to make progress as an out-patient or their handicap is too severe for out-patient care or for geographical reasons. Alternatively additional diagnoses such as depression or disordered eating may make out-patient treatment more complex. Others may be housebound, have a reversal of their sleep pattern or suffer from obsessional slowness so that attendance as an out-patient has become almost impossible. The program is also suitable for adolescents.

We also specialise in the rapid treatment of depression, and other anxiety disorders such as a specific phobia of vomiting, PTSD and co-existing problems such as borderline personality disorder and alcohol or substance misuse.

For anxiety disorders, it is also possible to be admitted privately to the Anxiety Disorders Residential Unit (ADRU) part of the South London and Maudsley NHS Foundation Trust). This is only suitable if you do not need nursing care as the therapy staff are there from 9am to 5pm. Note that ADRU is not authorized for insurance funding (e.g BUPA, PPP AXA) but you may be to reclaim from an overseas insurer.

OCD/ BDD/ SPOV Program

The emphasis is on individuals having a good psychological understanding of how your solutions have become their problem and the implications for overcoming their problems. Once patients are engaged, they are expected to conduct exposure or behavioural experiments daily and complete their homework diaries and weekly ratings of outcome. In addition, all staff may model exposure or participate in behavioural experiments to help test out a patient’s beliefs.

In-patients with OCD or BDD receive:

  • Three individual sessions of CBT with their key therapist
  • A specialist nurse therapist or OT who supports you
  • Group CBT sessions which are specific to OCD or BDD.
  • A wide range of other groups for related problems such as depression, low self-esteem or social anxiety.
  • Regular monitoring of progress which is used to audit outcome.

Medication is also reviewed. A SSRI or clomipramine or augmentation of a SRI may be offered. CBT may have a better outcome when combined with an SRI than CBT alone in those with moderate to severe impairment but patient’s make the decision whether to combine treatments.

An initial assessment gives us an opportunity for a treatment plan to be jointly agreed with a patient prior to admission. If this not possible, then an initial assessment may be conducted as a home visit or over the telephone/ Skype. A formal assessment of response to treatment is completed on the ward within the first 2 weeks. This assessment is focused on the patient’s ability to engage in treatment. Partners and relatives are encouraged to meet with the therapy team. The team will want to assess their involvement and they will be advised on how best to support a patient’s treatment.

We aim for patients to be able to travel (if necessary with a relative or friend) so they may return home on therapeutic leave as soon as possible at weekends to practice exposure in their own environment. NHS patients must have an identified local care coordinator who can discuss follow up arrangements and attend a Care Programme Approach (CPA) meeting with a family member. There should be follow up by a local cognitive behaviour therapist who would preferably act as the care co-coordinator. Alternative follow up arrangements including telephone consultations and day-patient or out-patient care can also be arranged.

Rapid treatment of depression

We are offering with Triple Chronotherapy for the rapid treatment of depression. Not everyone is suitable. There are three main components  namely Wake Therapy, Phase Advance of sleep and Bright Light Therapy. Wake Therapy includes sleep deprivation for one night then advancing the time you go to bed during the first 5 days.  In the longer term, the focus in treatment is on daily light therapy, Behavioural Activation or Cognitive Behaviour Therapy, sleep hygiene and changes in your lifestyle (for example diet and use of alcohol). If the chronotherapy works, and there is improvement in your mood over the first week then you can tackle longer standing problems such as conflicts or losses in your life that may be contributing to your depressed mood.

Teaching

There are attachments for medical students from the Royal Free and University College Medical School. As an in-patent, you do not have to see a student but it is helpful for their training. We also have psychology students on placement from Bath and KCL who assist in the OCD and depression programme.

Self-help groups

We provide premises for self-help groups for OCD and BDD, which meet once a month at The Priory Hospital, North London. Groups are free of charge. For further information contact OCD Action at 020 7226 4000.

Obtaining NHS funding for treatment at The Priory

It is sometimes possible to obtain NHS funding for in-patient care at The Priory North London but it is difficult to initiate this yourself. Even when you follow the recommended route, it does not guarantee funding and if you are successful, it will not usually happen immediately. The recommended route is:

  1. See your GP and seek a referral for an assessment to your local mental health services or under the reforms, with a consultant team of your choice.
  2. Your community mental health team will then assess you and will probably want to attempt treatment locally.
  3. If local treatment is unsuccessful then and you have OCD or a related disorder they may consider referral to our NHS service at the Maudlsey Hospital (out-patient service) or at the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital.
  4. If you need in-patient care at The Priory North London and cannot be treated as an out-patient or at the residential unit at the Bethlem then your local team may seek funding from your local Clinical Commissioning Group. This does necessarily mean that funding will be successful as there many competing priorities within the NHS and they have a limited budget. In you meet certain criteria, it is possible for adolescents or adults with OCD or BDD to obtain funding from the Highly Specialised Service for severe treatment refractory OCD and BDD. This is funded centrally by NHS England (and not your local Clinical Commissioning Group). Again you must be referred by your Community Mental Health Team. In general, the care pathway for severe OCD for someone that requires admission with nursing care is for Springfield Hospital unless there are unusual circumstances. If you have severe OCD and nursing care is not required then you may be referred to the Anxiety Disorders Residential Unit.  In general the care pathway for severe BDD that requires admission with nursing care is for Priory Hospital. If you have severe BDD and nursing care is not required then you may be referred to the Anxiety Disorders Residential Unit. Adolescents with severe OCD and BDD, the route is first to be assessed by Dr Bruce Clark’s team at the Maudsley Hospital and they will recommend admission if necessary to the Priory.

In reality, only those with severe distress and handicap (for example at risk of suicide or being very disabled) obtain NHS funding for in-patient care. The best advice is to work with your local services and if necessary seek advice from the advocacy service at OCD Action.

Legal bit

My private work is conducted through my company, de Coverly Limited, Trojan House, 34 Arcadia Avenue, London N3 2JU. Registered in England & Wales, Registered Number: 7960388.