The NHS is, in many ways, a brilliant organisation and I'm well aware that I'm lucky to live in a country that has 'free' (well, we're all paying national insurance, so not quite) healthcare for its citizens. However, the reality is that ACL reconstruction and revision ACL surgeries are both 'elective' procedures and therefore relatively low priority and liable to cancellation.
I'm fortunate to have private healthcare, which I hoped I'd never need to call on, and going through four surgeries over the last six years has certainly taught me a little about how the private health system works.
With the NHS, we're used to seeing our GP, being referred and receiving an appointment, attending that appointment and everything basically being organised for us from there. The private system (I've gone through two different insurance companies and two different hospital groups) seems to be a little different.
Here's my guide to 'things you need to know' if you're lucky enough to go private:
You may not need to go to your GP to get a referral. Some health insurance companies are happy to take a referral from a physiotherapist for orthopaedic issues. If you do get a referral from your GP, it doesn't actually matter who the referral letter is addressed to (first time around my GP practice had a standard letter they gave you but the referral was accepted by a completely different consultant at a completely different hospital). Oh yes, and I had to pay for the letter.
There's a lot of talk about choosing the 'right' consultant but finding information about who's out there is actually pretty difficult. Your GP / physiotherapist may be able to offer advice / have someone they work with regularly or you can look up consultants via their hospital or practice website. Be warned, the profiles aren't very revealing though - they're all great at what they do and specialists in the field. Insurance companies may push you to see 'approved' or 'fee assured' consultants on their lists or you could be restricted to a choice of hospitals by the detail of your policy. There are a few websites out there that claim to publish surgeon data but, in most cases, this is limited to morbidity rates and, frankly, I'd hope with ACL surgery that wasn't something to worry about too deeply! Trawling chat rooms, such as KneeGuru can often throw up some useful 'starters for 10' and general advice seems to back 'choose an NHS consultant working privately, they're doing these ops all the time'. It's also worth considering whether you're dealing with an out and out knee specialist or a more general orthopaedic surgeon who promotes themselves as specialising in knees, hips, shoulders, ankles...
Making your appointment: sometimes this will be done for you, sometimes you need to call the hospital, sometimes the consultant's secretary. I'm still not sure what the expected protocol is but, in my experience, dealing with the consultant's secretary directly is usually the most effective
Look out for middle men getting involved with the referral process. Much like you can often be pushed into using a car insurance company's preferred claims handling company after a car crash, similar companies exist in the health insurance industry and may offer to take over the admin of your treatment if you use one of their consultants. That may sound like a great idea. Or maybe not.
If you're using health insurance, make sure you get an authorisation for treatment before booking your appointment. Some insurance companies are better than others at this stage. One company I had to call for a new code for each individual thing (e.g. consultation, MRI, x-ray, follow up appointment, physio etc); the other has generally given me a code covering several likely requirements at once, which makes things much easier.
Check your anaesthetist's fees are covered by your insurer too. Private consultants seem to have regular anaesthetists they work with but, just because the consultant's fees are within your policy limit, doesn't mean their preferred anaesthetist's will be too.
All drugs, dressings etc prescribed while you're an inpatient will most likely be covered by your insurance policy but once you leave the building, it's a different matter. First time round I left with a private prescription for pain killers for use at home and an invoice for the price of my crutches
After your surgery, you'll usually be visited by a physiotherapist and have an appointment made for your first follow up session. This is quite a neat way of keeping your treatment within the hospital group. Yes, it does make sense if the physio team works closely with your consultant but it doesn't necessarily mean they're the best choice for you. First time round, my 'in house' physio team were great; second time round, less so. You don't have to undertake your rehab with them so it's worth putting as much effort into researching your physio team as you did your consultant in the first place
Have I mentioned that physio is really important when it comes to optimising the outcome of ACL surgery (swats the bee in her bonnet)? If you're using health insurance, it's definitely worth checking out how much physio you can have under the terms of your policy. Some policies cap the value of physio annually, others roll it in with other 'outpatient' services (which means you can quickly run out of sessions) and others, while not limiting treatment directly, put pressure on 'approved' physios to average a certain number of appointments across all conditions, with the threat of being removed from the 'approved' list if averages begin to rise. Whatever your circumstances, find out where you stand and be prepared to pay for the extra if you need to
Check whether or not you'll be copied in on letters about your treatment between your consultant and your GP/physio team. In one hospital group, I was cc'd on everything, which was great for clarifying exactly what had been diagnosed or advised; with the other, I have no official correspondence.
Finally, don't expect that just because you've gone private, everything will run like clockwork. Not being able to get through on the phone, outpatient appointments running late by nearly an hour (I'll take the stitches out myself, thanks), nurses advising others how to fill in the paperwork to 'cover their backs' in front of you, tables being dropped on your newly-operated leg, discharge delays and leaving you without food for hours (as they forgot you were back and hadn't informed the catering team), seem to happen with relative frequency, NHS or private!