Private consultations

I am a Consultant Psychiatrist at the Nightingale Hospital where I admit private patients. It is conveniently located in central London.

Appointments for a private assessment can be made by telephoning my secretary, Lisa Weller, telephone: 020 3137 9911 or email here. It will speed up the process if you first register here so that my secretary can then offer you an appointment.

Location

Consultations can be made by remote videoconference if you can complete various questionnaires beforehand and return them to my secretary before the consultation. Face to face consultations can take place with masks and social distancing at a consulting room near Highgate on Wednesdays or Fridays at the Nightingale Hospital.

Referral

For private consultations, it is helpful to have a referral with any background information 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 often 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 1-2 months to see private patients but will endeavour 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.

Fees

I charge £350 for an initial assessment (about 60-75 minutes). This includes a written summary and any recommendations. Follow up appointments are £150 (for half an hour), £225 (for 3/4 hour) and £300 (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.

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. For therapy, I will usually recommend a trusted colleague as I have a limited capacity in my private practice as I also work in the NHS or in research.

I will see a patient for an assessment with a person’s partner or relative if requested by a patient. 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 to you which can be sent to your GP, Consultant or therapist. You may also withhold consent for a report to be sent to anyone.

Directions

Travelling to Nightingale Hospital

Nightingale Hospital is situated in Marylebone, in the heart of central London.

Travelling to the hospital via public transport

• Nightingale Hospital is a two-minute walk from Marylebone train and Underground station, served by the Bakerloo Line.
• The hospital is also within walking distance of Baker Street and Edgware Road Underground stations. In addition, the area is also well served by London buses.
• Its excellent public transport links enable ease of travel across the capital and to all London mainline train stations and London airports.
• The Eurostar terminal at St Pancras International Railway Station is approximately a 15-minute taxi ride from the hospital.

Travelling to the hospital via road

• Lisson Grove is off the A40 Marylebone road.
• The hospital is in a metered area, with several ‘pay and display’ bays nearby. There is a NCP Car Park nearby.

For  my consulting rooms in Highgate, my secretary will send you directions. I do not see private patients at the Maudsley or Bethlem Royal Hospitals.

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 emetophobia. Please see the Adolescents page for more information.

International patients

I am not covered by my medical insurer for patients who are not living in the UK. Their rule is that patients have to reside in the UK at least as a temporary visitor before I can assess you.

Treatment programmes

The Nightingale offers intensive treatment programmes for Obsessive Compulsive and related disorders, other anxiety disorders and 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 or see you remotely

In-patient services at Nightingale

The Nightingale hospital is located in Marylebone, central London.

Individuals with an obsessive compulsive or related disorder 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, ASD 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.

We also specialise in the 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.

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 nurse therapist or student 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/ Zoom. 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. Follow up arrangements including remote 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 and then going to bed at 5pm for 8 hours. You then advance the time you go to bed over 4 days.

In the longer term, the focus in treatment is on daily light therapy, Behavioural Activation, sleep hygiene and changes in your lifestyle (for example diet and use of alcohol) and reducing rumination.

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-patient, you do not have to see a student but it is helpful for their training. We also have psychology students on placement who assist in the OCD programme.

NHS treatment

The recommended route for NHS treatment is:

  1. See your GP and seek a referral for an assessment to your local mental health services or for outpatient care 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 Maudsley Hospital (out-patient service) or at the Anxiety Disorders Residential Unit at the Bethlem Royal Hospital
  4. If you need in-patient care 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. If you meet certain treatment refractory criteria, it is possible for people 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.

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. The best advice is always to work with your local services.

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.