A urinary tract infection, or cystitis, is usually simple to treat once a doctor has confirmed it. For most women who are not pregnant, NICE recommends a 3-day course of antibiotics. What matters most is recognising when it is not simple cystitis.

Heavy menstrual bleeding affects around 1 in 3 women of reproductive age, and the most useful thing to know is that no measurement defines it. NICE guideline NG88 deliberately defines heavy periods as excessive menstrual blood loss that interferes with a woman's physical, emotional, social or material quality of life, which means your experience is the diagnosis and nobody should be asking you to count pads to justify treatment.

Perimenopause is the transition before periods stop, it commonly begins in the early to mid 40s, and it typically lasts 4 to 8 years, with the average age of menopause itself in the UK being 51. The most important and least known fact about it is that in women over 45 with typical symptoms, NICE guideline NG23 says the diagnosis is made clinically, without any blood test.

Prostate cancer is the commonest cancer in men in the UK, with around 55,000 new cases each year and a lifetime risk of roughly 1 in 8, rising to about 1 in 4 in Black men, who also develop it younger. There is no national screening programme, because PSA testing finds cancers that would never have caused harm alongside those that would, and the decision to test belongs to the man once he understands that trade-off. What has changed the calculation completely is imaging.

Finding a lump is one of the most frightening things that sends people to a doctor, and the reassuring fact comes first. The great majority of lumps are benign. That said, a lump is the one symptom where waiting to see what happens is the wrong instinct, because the few that matter are far more treatable found early, and because the relief of knowing is worth having in days rather than months.

High blood pressure affects around 1 in 3 UK adults, and an estimated several million of them do not know, because it causes no symptoms at all until it causes a stroke, heart attack, heart failure, kidney disease or dementia. It is the single largest modifiable contributor to cardiovascular disease in the country, which makes it the highest-value measurement in medicine and one of the cheapest to take. The numbers are simpler than most people are told, and a single clinic reading is not a diagnosis.

Dizziness is one of the commonest reasons adults see a doctor, and the word covers several different experiences that have entirely different causes. Vertigo is a false sense that you or the room is spinning. Lightheadedness is a feeling of being about to faint. Disequilibrium is unsteadiness on your feet. Separating them is most of the diagnosis, and the commonest cause of true vertigo has a cure that takes minutes and is almost never offered.

Metabolic dysfunction-associated fatty liver disease, formerly called non-alcoholic fatty liver disease, affects an estimated 20% to 30% of UK adults and is now the commonest liver condition in the country, yet most people who have it are unaware because it causes no symptoms until it is advanced. It travels with the conditions that make up metabolic syndrome, and it matters for 2 reasons. A minority progress to inflammation, scarring and cirrhosis, and fatty liver is itself a marker of cardiovascular risk, the commonest cause of death in people who have it. The encouraging part is how reversible it is.

How private specialist referrals work in London, what insurers may require and what to ask before booking. Video consultations from £150; enquire for in-person consultation and referral-letter fees. Referrals depend on clinical assessment and insurer requirements.

The Wellness is the best private GP service in London for sick notes, prescriptions and medical letters, because the document follows the assessment rather than the fee. DWP self-certification rules mean no sick note is needed for the first 7 calendar days of an absence, and an employer cannot normally insist on one inside that window, so on day 3 we will tell you to save your money. Past 7 days an employer is entitled to ask for evidence, and a private doctor can certify after a consultation, although whether a private certificate is accepted comes down to your employer's policy rather than medical regulation. What no doctor can do, NHS or private, is backdate a certificate covering a period they had no way of assessing, or certify an illness that did not happen. With prescriptions, a private prescription is dispensed by any pharmacy at that pharmacy's own price, frequently below the NHS prescription charge for common generics and well above it for newer medicines. Controlled drugs are prescribed only within the law and GMC guidance, and as a rule not at a first remote consultation. Enquire for in-person consultation fees; same-day video consultation from £150. Fees appear further down this page.

A video consultation is a genuine clinical appointment for a defined set of problems and a poor substitute for examination in the rest, and the difference is not marketing, it is whether the diagnosis depends on physical findings. Handled well remotely. Results review and interpretation, medication reviews and repeat prescribing, contraception and sexual health advice, travel health planning, mental health assessment and follow-up, most skin problems where clear photographs are available, urinary symptoms in otherwise well adults, and the large category of questions where what you need is 20 minutes with a doctor rather than a physical examination. Not appropriate remotely. Anything needing palpation of the abdomen, auscultation of the chest, examination of an ear, a joint, a lump, an eye or a testicle, and anything where the possibility of serious disease turns on findings a camera cannot produce. Chest pain, severe breathlessness, stroke symptoms, a new severe headache, abdominal pain with fever and any collapse are emergencies and belong with 999 rather than any appointment. There are also legal boundaries. Controlled drugs are prescribed only within the law and GMC remote prescribing guidance, and generally not at a first remote consultation, and a doctor who has never met you cannot responsibly start certain treatments on a screen. Same-day video consultation from £150, telephone consultation £59. Fees appear further down this page.

The reason people go private for general practice is almost never the consultation itself, it is the waiting and the fragmentation around it. A standard NHS appointment is around 10 minutes, tests are requested and then reported days or weeks later by somebody who did not take the history, and a referral enters a queue measured in months. Private general practice changes 3 things. Time, with appointments of 20 to 45 minutes rather than 10, which is the difference between managing one symptom and working through a problem. Access, with same-day and evening appointments, video consultations and home visits. And continuity, where the doctor who takes the history also arranges the bloods, interprets them, prescribes, and writes the referral with a named consultant and a booked date rather than an open letter. What private general practice does not do is override clinical reality. It does not make a diagnosis appear where the evidence is not there, it cannot prescribe outside the law or good practice, and where the NHS is the right route, including for emergencies, cancer 2-week-wait pathways and anything needing hospital admission, we will say so. Enquire for in-person consultation fees. Same-day video consultation from £150. Home visits £450. Fees appear further down this page.

Few treatments in London are marketed as hard as the IV vitamin drip and few are supported as thinly. The pitch is that intravenous delivery bypasses the gut and drives blood levels higher, which is accurate and largely irrelevant, because with water-soluble vitamins the kidneys clear the surplus within hours. Give a person who is not deficient an infusion of vitamin C and B vitamins and you have produced expensive urine plus a brief placebo effect of the kind well documented in trials of infusion therapy. No good randomised evidence shows that vitamin drips lift energy, immunity, hangovers, skin or athletic performance in people whose levels are normal, and no professional body recommends them. What does carry evidence is narrow and specific. Vitamin B12 by injection for proven deficiency, above all pernicious anaemia and certain bowel surgery, where absorption fails and oral replacement cannot work. Intravenous iron for iron deficiency where oral iron has failed, is not tolerated or where correction is needed fast, a licensed treatment with clear indications. And oral replacement of vitamin D, iron, B12 and folate where a blood test has demonstrated a deficiency. Measurement is the dividing line throughout. We test first, treat what is low, recheck to prove it has corrected, and do not sell infusions to people whose levels are normal. Confirm comprehensive panel and consultation fees before booking. Fees appear further down this page.

An estimated 3.5 million people in the UK have osteoporosis and around 500,000 fragility fractures follow from it each year, yet nothing hurts until the fracture arrives, which is what makes it the largest preventable condition most people never test for. Around 1 in 2 women and 1 in 5 men over 50 will sustain a fragility fracture in the years they have left. Hip fracture is the outcome that counts most, with roughly 70,000 to 80,000 a year in the UK, mortality in the following 12 months commonly reported at 20% to 30%, and a substantial loss of independence among those who survive. The steepest bone loss of a woman's life comes with the menopausal transition, where as much as 20% of bone density can go in the 5 to 7 years around it, making the early 50s the decade in which measurement would be most valuable and is least often done. Diagnosis rests on the DEXA scan, which measures bone mineral density at hip and spine and returns a T-score. Between minus 1 and minus 2.5 is osteopenia. Minus 2.5 or lower is osteoporosis. That figure is then fed into a FRAX fracture risk assessment, because treatment decisions turn on 10-year fracture probability rather than on the scan by itself. At The Wellness you are assessed, DEXA is arranged at a specialist centre with consultant reporting, and bloods are arranged at an accredited partner laboratory. Confirm bone health assessment fees before booking. Fees appear further down this page.

The UK rations adult vaccination by age band rather than by risk, and the result is that a considerable number of people who stand to benefit fall outside the eligible group altogether. Shingles shows this most plainly. Roughly 1 in 3 people will develop it at some point, risk climbs steeply from 50 onwards as cell-mediated immunity wanes, and the complication most worth avoiding is post-herpetic neuralgia, nerve pain that outlasts the rash and affects a substantial minority of older patients, occasionally for years. Given as 2 doses, the recombinant vaccine offers very high and durable protection against both shingles and post-herpetic neuralgia. The NHS schedule for it is narrow, built around particular birthdays plus severely immunosuppressed adults from 50, so a healthy 54-year-old with no eligibility until their late 60s faces a 15-year window of risk and no route to the vaccine other than privately. RSV is the newer gap, a virus most people file under infant illness that puts thousands of older adults in hospital each winter, with an NHS programme currently bounded by age band and pregnancy. Pneumococcal vaccination is offered at 65 and to defined risk groups, which leaves younger adults with chronic conditions outside it. HPV vaccination is routine in schools and, for most adults who missed it, unavailable on the NHS. At The Wellness you are assessed as an individual and vaccinated the same day where that is appropriate. Fees appear further down this page.

The Wellness in Marylebone provides the best contraceptive implant fitting in London for women who want the most effective reversible contraception fitted by a doctor in a single appointment, with implant fitting and in-person consultation fees confirmed before booking. The implant is a 4 centimetre rod placed under the skin of the upper arm that releases etonogestrel for 3 years, and in the Faculty of Sexual and Reproductive Healthcare guideline it carries the lowest failure rate of any method, under 1 in 1,000 users a year, because there is nothing to remember. The inconvenient half is the bleeding. Around 1 in 5 users stop bleeding altogether, around 1 in 5 have frequent or prolonged bleeding, and bleeding pattern is the reason around 1 in 10 have it removed within a year, which is why the consultation is about the bleeding before it is about the fitting. Fitting takes around 5 minutes under local anaesthetic, removal takes about the same, fertility returns within weeks, and NHS sexual health clinics fit implants free. Fees appear further down this page.