Getting treated in the UK: NHS, private or insurance
Quick summary
- There's no national NHS rule for R-CPD, so it depends where you live.
- Paying privately can cost from about £900 to £6,000, patients report.
- Insurers vary a lot. Patients report Bupa and Aviva say yes most often.
Think you might have R-CPD (not being able to burp)? Good news: there are three ways to get treated in the UK. The NHS, paying yourself, or insurance. This is how things stand in November 2026.
The NHS: the official line
There's no national NHS policy for R-CPD (no one rule for the whole country). NICE, which advises the NHS on which treatments to use, has no guidance either. In December 2024 it said there wasn't much evidence yet. It also noted specialist advice that the treatment "is not being carried out in the NHS (but is being performed privately)", and it isn't writing guidance on it (NICE (opens in a new tab)).
On 15 October 2026, the Government replied to a petition asking for better NHS access. It said Botox isn't licensed for R-CPD (not officially approved for it), so doctors use it "off label", meaning for something it isn't officially approved for, when they think it's right. Local NHS teams decide who gets it (petition 770872 (opens in a new tab)). By 11 November 2026, 12,722 people had signed.
The NHS in real life
Patients say some NHS ENT (ear, nose and throat) teams do treat it. These include Doncaster, Salford, Guy's and St Thomas', the Royal London, Queen Elizabeth Birmingham and Ninewells in Dundee (Find a specialist: UK R-CPD doctors). Always check with the hospital first.
It varies a lot by area (thread (opens in a new tab)). One patient saw ENT two weeks after a GP referral (your GP asking a specialist to see you) and got on the NHS Botox list (thread (opens in a new tab)).
Two NHS tools worth knowing
Right to Choose (England only). If your GP refers you, in most cases you can choose the hospital or service, including many private hospitals that do NHS work (NHS: your choices (opens in a new tab)). Ask for an ENT team that treats R-CPD.
Individual Funding Request (IFR). This is when a doctor or nurse asks your local NHS to pay for something it doesn't usually pay for. You can't apply yourself (NHS North West London (opens in a new tab)). One patient's IFR was turned down at first, because the consultant's (hospital specialist's) letter was missing details (thread (opens in a new tab)).
Paying privately
We couldn't find a UK clinic that shows its full price online. These are patient and press reports, so use them as a rough guide:
- Awake, in clinic: about £900 to £950 at one London clinic (thread (opens in a new tab)), or from about £1,250 with another surgeon (thread (opens in a new tab)).
- Asleep (general anaesthetic, medicine that puts you to sleep for the procedure): about £2,387 plus a £235 consultation (first appointment), or about £6,000 at one hospital (thread (opens in a new tab)). Or about £4,000 to £4,500 with one surgeon (thread (opens in a new tab)).
- In the news: patients paid about £900 to £3,000 (Mirror (opens in a new tab), MEN (opens in a new tab), BBC (opens in a new tab), The Sun (opens in a new tab)).
Health insurance: what patients say
No insurer we found has a policy on R-CPD. So we counted what patients shared on r/noburp (opens in a new tab) and in two Facebook groups. These are patient reports, and the numbers are small. Your own policy decides it, and we'll keep these up to date.
- Bupa: 34 of 38 reports were a yes (fully or partly), 4 refused.
- Aviva: 11 of 15 reports were a yes (fully or partly), 4 refused.
- Vitality: 18 of 25 reports were a yes (fully or partly), 7 refused.
- AXA: 15 of 24 reports were a yes (fully or partly), 9 refused.
- WPA: 2 of 2 refused.
The numbers change as more people share, so see our health insurance page for the latest.
What seems to decide it
- Pre-existing conditions (health problems you had before your cover started). R-CPD is usually lifelong, so this is a common reason for a no (thread (opens in a new tab)). Work schemes that ignore medical history go smoothest (thread (opens in a new tab)).
- "Experimental". Some insurers say it's not a recognised treatment, sometimes pointing to the lack of NICE guidance (AXA example (opens in a new tab), Vitality example (opens in a new tab)).
- "Temporary". One insurer was unsure at first, then said yes after the consultant's letter said one injection usually works for good (thread (opens in a new tab)).
- Repeats. A second injection is often refused (thread (opens in a new tab)).
Tips from patients: get a GP referral first. Get a yes from your insurer before booking (called pre-authorisation), using the procedure codes (the numbers insurers use for each treatment) from the consultant's secretary (thread (opens in a new tab)). If they say no, appeal (ask them to think again) with a consultant's letter. Expect to pay your excess (the part of a claim you pay yourself), reported at £100 to £250 (£250 (opens in a new tab), £150 (opens in a new tab), £100 (opens in a new tab)).
Whichever way you go, a great first step is our guide to talking to your GP.
This is a free resource and not medical advice. Speak to your GP.
Sources
- NICE prioritisation board decisions 2024 (opens in a new tab)
- UK Parliament petition 770872 and Government response (15 Oct 2026) (opens in a new tab)
- Find a specialist: UK R-CPD doctors
- NHS: your choices in the NHS (opens in a new tab)
- NHS North West London: Individual Funding Requests (opens in a new tab)
- r/noburp: Government responded (2026) (opens in a new tab)
- r/noburp: 2 weeks and on the NHS list (2026) (opens in a new tab)
- r/noburp: NHS IFR (2024) (opens in a new tab)
- r/noburp: cost of Botox treatment in England (2026) (opens in a new tab)
- r/noburp: in clinic treatment in London (2025) (opens in a new tab)
- r/noburp: consultation today (2026) (opens in a new tab)
- Daily Mirror, 14 Jul 2026 (opens in a new tab)
- Manchester Evening News, 19 Jul 2025 (opens in a new tab)
- BBC News, 30 Sep 2021 (opens in a new tab)
- The Sun, 26 Jan 2021 (opens in a new tab)
- r/noburp insurance threads, as linked above (opens in a new tab)
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