How Do You Price a Domiciliary Podiatry Round?

A domiciliary podiatry visit does not cost you thirty minutes. It costs thirty minutes of treatment plus its share of the driving, parking and setup for the whole round, which is usually somewhere between sixty and eighty minutes of your day. Price the round, not the visit, and the numbers change completely.

Most of what is written about domiciliary podiatry is about the mileage rate. The rate matters, and it has just changed, but it is a rounding error next to how tightly your round is packed.

What does a visit actually cost you in time?

Work it in minutes of day consumed rather than minutes of treatment delivered.

Take a seven hour working day, 420 minutes, and two versions of the same round.

Same practitioner, same working day, same thirty minute appointment. One version delivers half again as many visits.

What is that worth?

At a £45 domiciliary fee, and mileage costed at the 2026/27 approved rate of 55p:

A difference of £151.50 a day. Three domiciliary days a week across 46 working weeks is 138 days, which is roughly £20,900 a year of contribution, from routing alone.

No fee increase. No new patients. No conversation with anybody about money.

For comparison, putting your visit fee up by £5 across the scattered round earns £30 a day. The routing is worth five times the price rise, and unlike the price rise nobody has to be told.

Why is domiciliary yield lower than clinic yield anyway?

Because of the same arithmetic, and it is worth seeing plainly rather than assuming you are underperforming.

The UK Private Practice Barometer 2026 puts the median UK podiatry follow-up at £61 and the initial at £81. A clinic-based podiatrist working thirty minute follow-ups is generating around £122 per hour of chair time, with no driving at all.

A domiciliary visit at £45 that consumes 70 minutes of your day is generating about £39 per hour of day. Even at 47 minutes it is £57.

That gap is structural. You cannot close it entirely, and a domiciliary fee high enough to match clinic yield minute for minute would be well over £100 a visit, which the market will not pay.

What closes some of it:

Density, which is the lever above.

Recurrence. Routine nail care runs on a six to ten week cycle. One domiciliary patient is seven or eight visits a year, for years, with essentially no acquisition cost after the first.

Attendance. A housebound patient expecting you at their door is close to the lowest no-show risk in private practice. Our guide to no-shows with elderly patients covers where the remaining risk actually sits.

So the honest positioning is that domiciliary work trades hourly yield for retention and predictability. That is a reasonable trade, provided you are not also giving away the density.

How do you actually tighten a round?

Five things, in rough order of how much they return.

Assign days to areas, not patients to days. Monday is the north of the patch, Tuesday the east. A patient joins the day their postcode belongs to, not the day they ask for. This is the single decision that produces clustering, and it is uncomfortable for about a month.

Set the next appointment before you leave. Rebooking on the doorstep, into the correct area day, keeps the cycle aligned. Rebooking later by phone is how patients drift into the wrong day.

Align the recall cycle to the round. If a patient is on an eight week cycle and their area day comes round every week, the recall should land on the right week automatically. A recall system that surfaces who is due, by area, is the thing doing the work here. It is what Atlacare's recalls are for, and it is the one part of round management that genuinely does not want to live in a notebook.

Fill gaps with the waiting list, geographically. A cancellation on the north day should be offered to a north patient, not to whoever called most recently.

Cap the patch. The most common cause of a scattered round is a patch that grew by accepting everybody. Every outlying patient costs the round more than the visit earns. Declining politely, or charging an outlying supplement that reflects the real cost, is a legitimate business decision rather than a failure of service.

What limits how many visits you can do?

Two things that are not time.

Sterile instrument sets. You cannot reprocess between visits. The number of sterile nail packs you carry is a hard cap on the round, and it is often lower than the time available. If you are finishing rounds early because you have run out of instruments, buying more sets is the cheapest capacity you will ever purchase.

Physical load. Carrying a portable chair, drill and instrument cases into nine houses is not the same day as seeing nine people in a treatment room. Build the round for a body that still works in ten years.

What changed with the mileage rate?

The HMRC approved mileage allowance payment rate rises from 45p to 55p per mile for the first 10,000 business miles from 6 April 2026, the first change since 2011. Above 10,000 miles the rate remains 25p.

For a self-employed podiatrist claiming simplified expenses, that is what you deduct.

Note what this is and is not. It is an increase in your deductible allowance, not cash. An extra £1,000 of deduction is worth the tax and National Insurance you no longer pay on it, so a basic rate taxpayer keeps something in the region of a quarter of it. Useful, not transformative.

Also note the shape of it: the uplift only applies below 10,000 miles. A podiatrist driving 18,000 miles a year gains the same £1,000 as one driving 10,000. Which is another argument for the routing.

Our OT travel time guide covers the same rate change from a different angle, and note that some publicly funded work still operates on a separate 45p disbursement cap that did not move with the HMRC rate.

Simplified expenses or actual costs?

A real decision, and one you largely make once.

Simplified expenses means claiming the flat pence per mile and nothing else for the vehicle. No fuel, no servicing, no insurance, no capital allowances.

Actual costs means claiming the business proportion of everything the vehicle costs, including capital allowances, and keeping the records to support it.

The general position is that once you have used simplified expenses for a particular vehicle you must keep using them for that vehicle for as long as you have it. So the choice is worth a few minutes rather than a shrug.

Simplified usually wins for a high mileage, modest value car. Actual costs usually win for an expensive vehicle, an electric one, or a low mileage year.

Either way, parking and tolls are claimable on top of mileage. Parking fines are not.

The question nobody asks: is your journey even allowable?

This is the most valuable thing on this page and it is almost never raised in podiatry writing.

Travel between your home and a fixed place of business is generally not deductible, even where you work from home. That principle was applied firmly in Samadian v HMRC in 2014, where a consultant with a genuine home office was refused deductions for habitual journeys between home and the private hospitals where he held sessions, because those hospitals were themselves places of business.

The position is different for a genuinely itinerant practitioner. The older authority of Horton v Young treated a tradesman with no fixed business premises as having his home as the base of operations, making travel to varying sites allowable.

A purely mobile podiatrist, no clinic, patients' homes varying week to week, looks much more like the second case than the first. A podiatrist who runs a clinic three days a week and does domiciliary rounds on the other two has a harder question about the journey from home to the clinic.

This is fact specific and it is the sort of thing HMRC looks at. If a meaningful part of your income depends on the answer, put it to an accountant rather than to a forum. We have summarised the principles here, not verified the full judgments.

And check your car insurance

Social, domestic and pleasure plus commuting does not cover driving to patients. You need business use cover.

It is a small premium difference and a total claim refusal if you get it wrong, which makes it one of the worst risk to cost ratios in the whole operation. Check the policy wording rather than assuming, particularly if the policy predates your going mobile.

The short version

1. Measure minutes of day per visit, not minutes of treatment
2. Assign days to areas, then fit patients to days
3. Rebook on the doorstep, into the right area day
4. Buy more instrument sets if they are capping the round before time does
5. Charge an outlying supplement that reflects what an outlier really costs
6. Confirm your travel is deductible if you also have fixed premises
7. Confirm your car insurance covers business use

The fee is the last thing on that list for a reason.

Figures here are worked illustrations using survey medians and stated assumptions, not audited data. Mileage rates, tax treatment and the deductibility of home to work travel are fact specific. The case law summarised here comes from secondary sources rather than a full reading of the judgments. Confirm your own position with an accountant.

Sources: UK Private Practice Barometer 2026 · HMRC, simplified expenses if you are self-employed · HMRC Business Income Manual, travel expenses

Related: Reducing no-shows with elderly podiatry patients · Is VAT due on orthotics? · Should OTs bill for travel time?