1. Do I have to be referred by my GP?

A: We do not require a Referral letter. If you are insured, you should check with your insurance company if you may see Mr Bhat without a referral letter from your general practitioner. Your GP will receive a detailed letter after every consultation so that your file is updated. If you are self paying, Mr Bhat will see you without any referrals. If you wish to make an appointment, you can use a variety of options to contact Sarah (Secretary) including phone or e-mail. For expatriates and foreigners, Whatsapp and Skype are available. Video Consultation is offered to everyone upon request.

2. What do I need for my first consultation?

A: A referral letter from either your general practitioner or physiotherapist is not required. You should bring your insurance policy number and authorisation code for the consultation. Any X-rays, MRI scans or previous correspondence should also be brought to the consultation, if possible. If your x-rays/ Scans were done at a different hospital, you can ring the Radiology department in the hospital you are being seen by Mr Bhat and request for these images to be transferred online at-least a few days before your appointment.

3. Will I see Mr Bhat?

A: In the private sector, you will always see Mr Bhat. The private service is completely consultant led throughout your treatment pathway.

4. How long will the consultation last?

A: The standard new patient consultation lasts up to 20 minutes. Some conditions are very simple and a thorough explanation including demonstrations with anatomical models can take only 10 minutes. Some complex conditions can take much longer and Mr Bhat will have usually identified these patients and made allowances for extra time. Follow up appointments last up to 15 minutes but again can vary from a few minutes to 20-30 minutes. Either way, we hope that at the end of the consultation enough time has been given to fully explain the issues involved.

5. How much does a consultation cost?

A: Costs are usually covered by your insurance company as they are within the normal guidelines. Please discuss matters further with the Secretary if you have any queries regarding this. Prices are set according to the scales produced by the major insurance companies on all of whose lists Mr Bhat is registered. Mr Bhat is recognised as a Provider by all the leading insurers and will charge reasonable and customary rates which, with very few exceptions, are accepted by the Insurer.

6. Will I need an X-ray?

A. Conditions that affect bone such as fractures and arthritis often need x-rays. An x-ray will be done on the same day and the results discussed with you. Most Insurance companies cover x-rays as part of the initial authorisation, but please check first.

7. What if I need a Scan?

A: Scans (MRI, CT, and ultrasound) are expensive but the initial authorisation usually covers it similar to X-ray. Scans are usually performed on a separate day and a follow-up appointment is required to discuss the results. On the day of the scan, we recommend patients making a follow-up appointment for a week after your scan, by which time the radiology doctor will have had time to review the images and write a report and discuss this with Mr Bhat, if required.

8. What if I Need Surgery?

A: The decision for surgery is not always easy and adequate time will be offered to ensure you understand what is involved. Occasionally we ask patients to see the Hand therapist before surgery to discuss the rehabilitation postoperatively if particularly involved. Once you have decided on surgery you will have consented to the operation and an OPCS code given. A suitable date will be decided in the clinic or arranged with the Secretary.

9. What is Informed Consent?

A: Consent is a very important part of the surgical process. It is the process in which the patient and surgeon have the opportunity to discuss the planned surgery in detail and be fully aware of the alternatives to the proposed treatment, risks, consequences of those risks, benefits, the procedure including options for anaesthesia and recovery. A signed document outlining these is filed in the notes and a copy is retained for the patient. Mr Bhat will give you a detailed information booklet that is usually available in clinic, for routine operations.  You must read and understand it over the course of the following days, as you are required to sign a consent form on the day of the operation that warrants that you have read and understood it. These booklets were prepared by Mr Bhat to incorporate all your concerns. You will then have time to read and understand this information before the operation. This will empower you to ask questions at the time of consenting. In non- routine cases or patients seen at locations outside Spire Gatwick Park Hospital, we will request the secretary to e-mail the information booklet. You are required to contact the secretary if you have not received the e-mail.

10. What is the OPCS code that my insurer asked me to obtain?

A: The OPCS code will represent a particular operation. It will consist of a capital letter followed by four numbers. For example, a carpal tunnel decompression operation will have the OPCS code A6510. We should be able to give you the code once a decision has been made to perform surgery. Occasionally multiple OPCS codes are required and this would represent two or more different procedures being performed in the one operation. Once you have been given the OPCS code you should inform your insurance company to obtain authorisation.

11. What are Out-Patient, Day Case and in-Patient procedures?

A: These terms describe the amount of time spent in the hospital. An out-patient operation is similar to an out-patient appointment, you will probably be seen and dealt with in under an hour. A day case operation is performed after admitting you, but you are allowed home on the same day. Most of our operations are done as a day case. In-patients are kept in overnight following surgery. This may be for a variety of reasons such as co-existing medical conditions, social circumstances, more careful observation required etc.

12. What should I bring with me on the day of the operation?

A: The level of surgery and length of stay may dictate what you should bring. All patients may require waiting a few hours before the operation. It is advisable to bring a book or laptop to help pass this time. Newspapers will be provided. We would recommend a pair of slippers and bathrobe. Patients staying overnight may wish to bring wash bags and toiletries.

13. Local, General or Regional anaesthetic?

A: Local anaesthetic involves injecting a solution around where the operation is to be performed, whilst you are entirely awake. It is usually administered in the operating room by Mr Bhat. The area takes 5-10 minutes to become numb. Mr Bhat will not start the operation until satisfied the anaesthetic has worked. You are not required to fast for a local anaesthetic.

Some patients prefer to have conscious sedation administered in addition to the local anaesthetic. The sedation is administered by a consultant anaesthetist. You are required to fast if conscious sedation is administered.

Regional anaesthetic (Blocks) involves injecting the local anaesthetic solution in the neck or armpit to anaesthetise the whole arm whilst you are still awake. this is administered by a Consultant Anaesthetist. My regular anaesthetist is highly skilled and we prefer this form of anaesthesia, as it is best for you.

General anaesthetic involves putting you to sleep for the duration of the operation. At the end of the operation either local anaesthetic is injected into the wound to provide post-operative pain relief or the anaesthetist has performed a regional block.

14. Who will do my operation?

A: Mr Bhat performs all operations. Occasionally for complex cases, he may have an assistant. There will be no extra costs incurred if an additional surgical assistant is required.

15. Who will I see after my operation?

A: We will usually check that you are comfortable and in a satisfactory condition to leave the hospital. You will be followed up in the outpatient’s department either by a nurse, a hand therapist or Mr Bhat, If there is a simple bandage this is reduced after 7-14 days in clinic. You may be seen for mobilisation or splinting by a hand therapist in the first week.

16. What if things go wrong?

A: Complications are fortunately quite rare in hand and wrist surgery. However, they still can occur. The close postoperative attention that you will receive from the nurses, hand therapist and Mr Bhat would hopefully identify any problems early so that they can be rectified. You are free to call the hospital where your operation was performed and ask to speak with the Resident Medical officer or the duty sister, who may arrange to see you. If necessary, they will contact Mr Bhat to ensure that prompt and correct management is initiated.

17. What is the waiting time to see Mr Bhat?

A: In the private sector you can usually be seen and operated on within two weeks. Mr Bhat and his Secretary control the waiting list diary, and every patient is operated on by Mr Bhat usually within two weeks. In the NHS, the waiting time is controlled by the waiting list office and patients may have to be allocated to juniors or colleagues if there is a long queue.

18. Can I see Mr Bhat privately to reduce my waiting time for Surgery?

A: Anybody can see Mr Bhat privately. If you subsequently wish to be treated or operated on the NHS by Mr Bhat, we cannot guarantee this outcome due to the NHS treatment pathways that have to be followed. However, you will not have to see Mr Bhat’s team again, if your GP ensures that a copy of Mr Bhat’s letter is attached with the NHS referral.

19. I am not Insured. How do I self-fund my treatment privately?

A: You will incur the full amount of the initial Consultation with Mr Bhat. If you decide to have Surgery, you will be given the operation code. You will usually be able to get a fixed price quotation from the business office.

20. I had an accident abroad on holiday. How do I transfer my care to Mr Bhat?

A: We will see you without the GP letter. However, please check with your insurer first and seek authorisation. It is helpful if you bring any x-rays and clinical information from abroad, but you can still be seen if you do not have access to this information.

21. How do I pay Mr Bhat?

A: The Secretary will send you an invoice. You will have 30 days from the date of the invoice, to complete payment. This is usually by BACS online payment. The bank details will be on the invoice. You may contact the Secretary for the bank details, in case you cannot find it on the invoice. Cheques are payable to Ukorthocare ltd (please write the invoice number on the back of the cheque). If the payment is not received within 30 days, you will be sent 2 reminders, followed by a debt collector. Please feel free to discuss any financial matters that you do not understand, with my secretary.

22. What are the outcomes of Hand Surgery?

A: The Outcomes of Hand Surgery is very dependant on Hand Therapy. Hand therapists are highly specialised in treating hand diseases. Their input is critical to obtaining excellent outcomes and we are heavily dependant on them. It is vitally important to recognise the difference between a general physiotherapist and a Hand therapist. It is no good seeing any physiotherapist, as the Hand is very intricate and requires a physiotherapist or an occupational therapist with special skills. These skills include the fabrication of thermoplastic splints, compressive gloves/garments, mirror therapy for complex regional pain syndrome, etc. Hand therapists qualify after sitting a series of testing examinations conduct by BAHT (British Association of Hand Therapists).

23. Can I use my private insurance to see Mr Bhat?

A: Yes, of course. Irrespective of whether you have an injury or illness, you can exercise your right to private health care. However, ideally, you must let your GP know that you have private insurance and that you would like to use it. Usually, your GP will not ask you if you have private insurance.

24. Why do my Insurers say that you do not follow their guidelines?

A: Mr Bhat has signed up with all major Insurance companies including AXA and BUPA. Therefore, you should not face this problem. If you do, please ask to discuss the matter with the insurance agent’s supervisor. This will help them update their records and ensure you are seen by Mr Bhat. Some hospitals are not recognised by some insurers, which may include one of the hospitals where Mr Bhat attends. If so, you should contact his secretary to discuss your options instead of being persuaded to attend a different consultant/ hospital.

25. Is Mr Bhat a Hand Surgeon or a Foot Surgeon?

A: Over the years, Mr Bhat has developed an additional special interest in forefoot surgery. Mr Bhat regularly operates on Bunions, Hammer toes, Morton’s neuroma, big toe osteoarthritis and several other foot disorders.  Mr Bhat treats foot and ankle injuries routinely and constantly update my knowledge of foot surgery attending national and international meetings on foot surgery.

26. What if I need a Steroid injection in clinic?

A: There are a number of common conditions that will be treated by injecting steroids. These include carpal tunnel syndrome, trigger finger, tendinitis of the wrist, tennis elbow, arthritis of the hand, etc. The code for this is W9040 and I will let you know about this after the diagnosis is made at your first consultation. The steroid injection is NOT included with your consultation. You will have to ring your insurance company for authorisation. This will mean a delay in your treatment on the day or an extra follow-up appointment.

27. What will I pay if Mr Bhat was to perform my carpal tunnel surgery privately?

A: For self funding patients, we have started a new service for minor operations such as carpal tunnel release, trigger finger release, De-quervain’s release, removal of lumps, etc as an out-patient procedure. These procedures cost approximately £2000  if performed in the operating theatre. I am now offering the same service at out-patients for a fixed cost of £850. There is no other private hospital in the country that offers such an attractive price for surgery carried out by an experienced consultant.

The process involves an initial consultation with Mr Bhat. This is essential so that he can ensure that there is no additional or alternative diagnosis. He will also explain the surgery, the risks, consequences of those risks, benefits, recovery and alternative treatments. The initial consultation is £200. If you have seen me on the NHS and your diagnosis was confirmed, it may be possible to skip the initial consultation.

Once the decision to proceed with out-patient surgery is made, it will be timed for a 30 minute slot between 12-2 pm on Wednesdays. You will not require to fast, stop medications or bring anything with you. If you are on blood thinning tablets, we will discuss them with you at initial consultation. In general, warfarin can continue if the INR is less than 4.

28. I live Overseas. Is Mr Bhat happy to do video consultations?

Yes, we have expertise running Virtual clinics for the last 4 years. Mr Bhat was mentioned on the “One Show” for his innovative Virtual Fracture Clinics that is very popular with patients. He will see you by Video using Zoom or Skype. If you wish to do that, simply e-mail his secretary and she will arrange a convenient time and date and send you you a link by e-mail. Since the Covid-19 pandemic began, we have seen several patients via Zoom. The feedback is excellent. It is surprising how many patients can have a safe diagnosis and advice  by Video. We are certain that this technology is here to stay post Covid-19.