Payment of fees

*While this scenario has focused on an osteopath, it could also apply to a range of healthcare professionals who work in similar circumstances. The suggestions offered are examples, and not an exhaustive list of all possible actions or solutions.


David Joiner is a newly registered osteopath who joins a busy practice to work as a self-employed associate. The principal of the practice offers a promotion to patients whereby if they pay for ten treatments in advance, they receive one treatment free.


The principal of the practice asks that David actively promote this scheme to patients.

What the osteopath did

David explained his concerns to the practice principal, and asks what happens in circumstances where patients do not need ten sessions, and request a refund of monies paid up front. In talking this through, they realised that there is a potential conflict of interest in this scenario, and it was agreed that where ten sessions are not required, this will be explained to the patient, and a refund given.

For the future, the practice changes its promotion to offer a discount on the initial treatment fee to new patients recommended by existing patients, and on any tenth session only when this is required. They stop suggesting that patients pay for sessions in advance.

David considered whether such a scheme might present a conflict between the commercial needs of the business, and the therapeutic needs of patients who might not actually need the full ten sessions.

What the osteopath had to consider

  • Joint statement from the Chief Executives of statutory regulators of healthcare professionals.
  • The Osteopathic Practice Standards
  • The 7 principles of public life (‘Nolan principles’ May 1995) – apply to anyone who works in health, education, social and care services and give guidance on transparency and declaring any interests.