Packages Explained: 11 Reasons for Physios to Stop Selling Blocks of Sessions

We Need To Talk About Packages

Selling pre-paid blocks of treatment to patients has become par-for-the-course in MSK healthcare. On paper, it looks like a clever business move, lock people in, guarantee revenue, give a little discount to sweeten the deal. What’s not to like? Well plenty, actually, in my opinion.

Packages have become far too common in the MSK industry and they’re doing far more damage than people even realise and the frequency with which I have to discuss the pros and cons of ‘packages’ has now reached the stage where I have to lay out my thoughts clearly for me to be able to refer back to.

This article is likely to end up being considered ‘controversial’ as it always seems to be an emotive topic to discuss and I’ve no idea why because I don’t think it needs to be. I already know many people who disagree with me (maybe they will write a rebuttal). I also know many clinics are making packages work for them perfectly well and I respect that. I could even write a comprehensive argument in their favour (but I’m not this time). There is nothing in this article which is intended to point fingers at any clinic in particular or indeed you, the reader. Think of this as more of a philosophical disagreement – I truly believe that if you’re running a successful clinic offering package deals to all your patients then you could be running an even better clinic without them and I want to show you why I believe that.

For those that don’t know me, my name is Mark Reid and I’ve been a Physiotherapist for 13 years. I spent 10 years in MSK practice in a mixture of settings – occupational health, sport, NHS, private practice – eventually helping found my own clinic before moving into marketing full time to escape the daily grind of private practice. Throughout my time in clinical practice I had plenty of experience with the ‘packages’ phenomenon, I even sold plenty myself. But my experience of them as an employee of a practice that offered them was bad; as a clinician delivering care in them it was bad; my experience as a clinic owner was also bad. And now, as a marketing strategist, looking onwards at the industry, I can say that my experience with them here is also bad.

But before digging into why I think selling packages is a bad idea I think it’s best to start with why they’re a growing trend and what proponents “think” they achieve:

1. Reduce dropoff
2. Increase the chances that patients will return for the full course of treatment.
3. Stabilise cashflow for the business.
4. Simplify the admin.

Now with those potential positives in mind let’s discuss why I think treatment packages aren’t just unnecessary but are actively harmful to your clinic, your patients and your reputation.

1. Drop-off happens for a reason

• Packages cover up poor care instead of addressing why patients leave.

Patient drop-off is a major issue for both clinics and for patients. Not completing treatment plans leads to worse clinical outcomes (at least theoretically – some treatment plans were never going to work). Not only this but DNAs and cancellations are a pain for the clinic to deal with as it makes cashflow spikey and unpredictable.

And yet, if you do the digging on DNAs, cancellations and patient self-discharge rates across all the clinicians in the business you will see that some seem to be doing far better on these metrics than others. Why is this? Are they getting different patients? Are the clinicians with the lowest late cancellation rate just consistently luckier at who they treat than the others? No. It’s entirely dependent on the clinician themselves. The best clinicians do not struggle to ‘retain’ patients for a full recovery. In fact that’s one of the hallmarks of a great clinician – that patients repeatedly want to return to see them, and even recommend their friends to go too. But do you know who does struggle to retain patients? The clinicians who have no idea what the diagnosis is. The clinicians that struggle to build rapport with anything that has a pulse. The clinicians who are so under-confident in the care that they’re recommending that the patient is underconfident too.

Patients see value in great care – it’s why your best clinicians have far better rebook rates as well as superior outcomes. Delivering care that the patient values highly is a skill but it’s a skill that you need every single clinician in the business to hone. Selling packages to paper over the cracks of poor patient retention is at best a sticking plaster and in these circumstances it’s a sticking plaster to repair an earthquake.

If your clinicians aren’t good enough to consistently get patient buy-in then your clinical product has a fundamental flaw, one that if not addressed properly will bring it to its knees eventually anyway. Get your clinicians better at delivering care that patients value, or get better clinicians – those are your only real options to directly address the problem.

2. It’s Clinically Illiterate

• Packages force cookie-cutter blocks that ignore patient complexity.

Every patient is different – some recover in two sessions, others might need twelve. Some adhere to and respond brilliantly to rehab programmes at home, others need their hand held. They’re different people, with different problems, and different biology, and different psychology, and different social situations. Given the enormous complexity of pain and injury, if any two randomly selected people with say ‘acute neck pain’ took the exact same amount of time to recover it would be a miracle.

When someone asks how long it will take to get better or how quickly they can get back to playing football or return to work you will almost never give an exact answer because YOU DO NOT KNOW and you’re not psychic and you don’t want to make promises that you can’t keep. What you will do instead is give a likely range – “usually 4-6 weeks”, “often 2-3 months”, “all being well – 6 months” but definitely not “45 days precisely”. If you are confident that you can give an exact timeframe on someone’s recovery from just an initial assessment then you are either a) God or b) worryingly overconfident in yourself. So if you can’t accurately predict precisely how long someone’s recovery will take, how on earth are you supposed to predict how many sessions it needs?

The end result of packages for clinical care is to remove any form of thought at all required:
Acute neck pain? “I’d recommend a block of six.”
Ankle sprain? “I’d recommend a block of six.”
Wrist fracture? “I’d recommend a block of six.”
Acute low back pain? “I’d recommend a block of six.”
Acute low back pain with some neurological symptoms? “I’d recommend a block of six”.

It is certainly easier to not bother with clinical reasoning and just sell everyone a block of six, but that is entirely clinically illiterate. Packages are cookie-cutter solutions that lead to cookie-cutter care for patients who deserve better. If patients weren’t valuing the care your clinic delivers highly enough before then selling packages isn’t going to make them value it more. It’s just going to tie them in.

3. Clinicians hate it

• Autonomy is lost, culture rots, good staff walk away.

Interesting personal fact – I once quit a job in private practice because I was being pressured into selling packages to every single patient. I won’t name the clinic and I wasn’t the only one to leave, but follow-up fact – they eventually went bust.

I didn’t enter clinical practice to sell prepaid blocks of treatment; I became a physio because I wanted to help people. The best clinics offer their clinicians the freedom to deliver gold-standard clinical care, and trust them to do so. But to deliver the best care possible I needed freedom. I needed to be able to alter a treatment plan half-way through to get the best results. I needed to refer to another professional when something wasn’t recovering as it should be. How on earth can I refer-on after 3 sessions when the patient has pre-paid for a block of six? My creativity and clinical freedom was stifled. I hated it. I was made to feel like my job was to sell and there’s a reason why I chose not to get a job at Carphone Warehouse.

Packages rotted the internal culture of the company faster than I could ever have imagined. Once packages were introduced, it didn’t take long before we started to be targeted on “package conversion rates.” The number started appearing in team meetings, in performance reviews. The clinic had turned into a sales company that happened to have plinths. And it just felt so alien to me. Management was delighted I’d sold a £400 package but I couldn’t care less the only metric that mattered to me was patient outcomes, retention, and referrals – not prepaid cash in the till. Packages shifted the focus from recovery to sessions remaining and patients started to treat it like a punch-card rather than a healing process.

4. It’s far too often unethical

• Clinicians are nudged to “use up” sessions even when unnecessary.

“Show me the incentive and I’ll show you the outcome.” Charlie Munger.

The anchoring effect of the ‘pre-paid’ number of sessions on clinicians is a strong one. It happens with insurance patients – Bupa has funded a block of five treatment sessions. How many clinicians are only billing Bupa for three of them? Of course they’re not, most are using all five every time even if the last two weren’t strictly necessary. And the same thing happens when people are paying cash. You’ve got six pre-paid sessions in the bank – do you push to fill them even if the patient is fine? Do you drag your heels on discharge because you’ve already been paid? Are those last two unnecessary sessions a bit like the last two weeks of school before the summer holidays?

With packages the incentives have switched from ‘delivering the best clinical care possible’ to ‘utilising the sessions that have been paid for in the best possible way’. That might seem like a subtle mindset shift but it is actually quite powerful and even if you’d never dream of being unethical, the nudge has still happened. I guarantee you’ll have a different patient visit average under packages as opposed to not.

Clinicians are not immune to these incentives. They matter. Targeting your clinicians on achieving a certain patient visit average will have an effect on their patient visit average. It’s what makes setting appropriate KPIs and targets such an artform. Both the HCPC and the CSP emphasise that patient care must always be “clinically justified, not commercially motivated”, but there simply is no way of introducing ‘packages’ that isn’t prioritising the health of the business over the health of the patient.

5. Patients aren’t that stupid

• Patients see through it. Packages erode trust and make care look like a commodity.

Let’s imagine for a second that none of the points I’ve made so far apply to you.

1. You’re a flawless clinician that has zero struggles with retention.
2. You’re a clinical nostradamus capable of accurately predicting any patient recovery
3. You’re ethical to a fault, the nudge factor of perverse incentives has no effect on you at all.

Even under that unlikeliest of circumstances you are left with another problem beyond your control – patients see through it.

They know it’s a tactic to lock them in and in healthcare perception matters – once people start doubting your motives, you lose their trust and trust is the bedrock of the therapeutic relationship. Patients come to you because they believe you can help them. The moment they feel you’re putting business interests ahead of their recovery, you erode their trust. They wonder if you’re keeping them longer than necessary to justify the package. Some will play along, but others will go elsewhere, because they don’t want to feel like they’re being sold to when they’re in pain.

Great healthcare isn’t about selling packages – it’s about solving problems. When you make care complicated with bundles and pre-paid deals you stop looking like a healthcare professional and start looking like a salesman and that’s not what people want when they’re in pain. They want reassurance, honesty, and clear steps to get better. Their pain is not a commodity. Stop treating it like one.

6. It Undermines Your Marketing

• Strong clinics succeed without bulk-buy gimmicks.

There’s a lot of different aspects to marketing but every strategy is ultimately trying to achieve the same thing – get more patients booked into the diary for you to treat. In order to do that you need people to find you and you need them to choose you. People are judging you before booking, they need to start to trust that you are someone who can help them. They need to believe that you actually can otherwise why would they bother?

A key part of marketing then is to have a great brand and offer a great experience and that’s what you’ll be spending a lot of time portraying in all of your marketing. So where do packages even sit with that?

Have a look around at high-performing clinics. None of them are running “bulk buy” offers. They charge properly, they get results, and patients stay because they trust the process, not because they’ve been financially handcuffed. Selling packages screams desperation. It tells the world that your service isn’t valuable enough to stand on its own, so you have to bribe people to commit. Imagine a top private hospital offering a “buy six GP sessions, get one free” campaign. You’d laugh at it and you should. Clinics often fall back to discount packages because their marketing isn’t effective otherwise but the best solution to that problem is simply to get better marketing.

7. It damages your brand and reputation

• Patients come for care, not a package upsell.

There is nothing more important to your brand than the experience a patient gets in their time under your care. That is your brand. But having your clinicians sell blocks of treatment creates a jarring experience. Patients don’t arrive expecting or even ready to spend £400-£600 up front. Many are anxious, worried, or simply unsure you’re the right fit yet, and they’re more often than not in pain! Some are off work, some aren’t able to pick up their children. They’re vulnerable. When you push a prepaid package before you’ve earned trust, you’re not offering healthcare – you’re running a sales funnel. You advertise expertise, but at the end of the assessment, they get a sales pitch. That’s not clinical care; it’s a classic bait and switch.

The pivot from clinical assessment to sales mode just feels clumsy to both patients and clinicians. At the end of the initial assessment instead of explaining the diagnosis, the recovery pathway, the treatment needed; you’re jumping into a pitch (I’ve seen the training given to clinicians when selling packages and this part is actually referred to as “The Pitch”). Patients will notice the vibe shift, and it will undermine your authority and risks instantly losing people’s trust. What credible clinician starts talking about discounts? If you’re supposed to be the authority on the injury and recovery, why are you negotiating like you’re flogging a Sky TV subscription?

8. It Attracts The Wrong Kind of Patients

• They leave for the next discount, draining long-term value.

Packages are a method of attaining and retaining patients, that is often entirely the opposite to what you’re trying to achieve. You’ve spent time and money building credibility, crafting ads, creating educational content, and positioning yourself as an expert. Then you undercut it all with a discount bundle. It’s like a Michelin-starred restaurant running a “buy two starters get one free” offer.

Now everyone loves a discount, but there’s a certain type of person who is attracted to them like a moth to a flame. They shop around hunting bargains on Groupon and Wowcher (it’s a bad idea, before you ask), buying things they don’t need because it looks like a great deal. But attracting bargain hunters is not the marketing strategy you want to aspire to. They don’t become loyal customers who sing your praises to their friends and they will drop you the moment someone undercuts you. Retaining patients is the by-product of clinical skill, communication, and trust. Not a direct debit. Patients should come back because they value you not because they forgot to cancel their direct debit.

9. It doesn’t fix financial problems, it makes them worse.

• Refunds, locked pricing, and discounts squeeze margins.

There’s a reason accountants hate packages. Under IFRS 15, such prepayments are classed as contract liabilities until the service is delivered. In plain English: that money isn’t yours yet, it’s deferred revenue. This makes reporting and forecasting near impossible. You end up with phantom revenue that looks good on a spreadsheet but can’t be touched because you haven’t actually delivered the service yet.

One of the most common issues with packages is unused sessions. Patients get better sooner, they move away, they change their mind, or life simply gets in the way. Suddenly you’re left in refund territory. Administering partial refunds fairly and consistently is a nightmare. Consumer protection law also adds complexity – under the Consumer Rights Act 2015, patients are entitled to refunds for undelivered services. That puts you in a legally grey area when you’ve already banked the cash. If you refuse or delay then you risk complaints, bad reviews, or even legal disputes. Instead of smoothing the business, packages create friction that can spiral into reputation damage.

Not only that but you’ve also locked your pricing. Once someone’s bought a six-session package at £50 each, good luck with raising your rates mid-year. I’m also yet to see a ‘package’ offer that doesn’t come with some kind of sweetener (discount) which quietly drags your average revenue per session down. So your average revenue per session is down and your pricing is locked while your costs are often uncontrolled. That’s not a nice combination of factors for any business to thrive in.

And why are you giving discounts in the first place? You already don’t earn enough. Barely any clinic charges what they’re actually worth and when margins are tight why would you voluntarily give away 10–20% because you think it “incentivises commitment.” It doesn’t. It just trains patients to expect a deal and to shop around for the best one. If you’ve got the best clinical product then believe in it and behave as such.

10. Even AI Thinks It’s a Bad Idea

• Despite absorbing pro-package arguments, it still finds the cons heavier.

I’ve now sat through enough seminars by industry gurus promoting packages as the cure to every clinic’s problems that I think I’ve encountered every single argument there is in favour of them. So in the hope of finding some great arguments that I’ve not yet encountered I turned to AI to write out the comprehensive list of pros and cons of treatment packages and get its opinion on the balance of the debate.

My GPT is fairly blunt, I’ve instructed it to be so. It told me simply that the “cons outweigh the pros.”

It’s worth pointing out here that all AI/LLMs are trained on internet content and have swallowed all of the marketing fluff that proponents of packages have ever put out there and when even it says, “hmm, this could easily be unethical” you know you’re probably doing something wrong.

11. Gurus and Coaches Push It For Everyone

• Gurus promote packages because they’re easy to coach at scale.

Most of the people shouting about packages and encouraging you to implement them have never treated a patient in their lives. They sell “systems” that promise predictable revenue but ignore clinical context. They talk about “reducing churn” like this is Netflix, not treating people in pain. They have a one-size fits all solution to every single clinic looking for advice. They rarely compare metrics before and after and when they do they just end up confused by confounding variables.

Poor clinicians offer the same cookie-cutter treatment plan to every patient who comes through the door. They don’t take time to understand the patient’s circumstances as it doesn’t matter anyway. Everyone gets the same treatment recipe, complexity is ignored. That’s what poor care looks like. It’s also what poor business advice looks like.

If a guru is pushing every single clinic to offer packages then they’re lazy at best, at negligent at worst. They haven’t taken the time to understand your clinic. They haven’t taken the time to come speak to your clinicians to understand and solve your retention issues. They’ve given you the same advice they give everyone because they are coaching at scale and cannot give you the time and attention you actually need. They push it because it’s a simple quick fix they can push on everyone and they don’t have the time and/or skill to give better advice. You should expect and demand better.

Final Thoughts

If you’ve managed to get all the way through this lengthy position statement then I both thank you and commend you. If you’ve done so with rage simmering up inside because you offer packages and think they’re the main reason for your clinic’s success then please do not take this rant as a personal insult as that is not the intention. Your clinic may well be a success but I believe that’s because you’re doing a lot of other things very well, packages are not the key variable. In fact, I’d encourage you not to undermine the great work you’re clearly doing by pinning your success to a certain sales technique.

I believe the supposed benefits of packages – predictable revenue, patient commitment, better retention – can all be achieved in better ways that don’t undermine trust.

1. Back yourself. Be clear and confident in your treatment plans. Assess the patient, explain the plan, outline the likely recovery timeline and what’s needed, and book the next session. That builds confidence. It says: “We’ll work together to get you better.” Patients will commit when they believe in the plan, not because you give them a discount.
2. Offer flexible follow-ups. Book the next session at the end of each appointment. Patients like the sense of progression and control.
3. Focus on experience, not price. Patients come back because they feel cared for, listened to, and supported – not because you gave them 10% off.
4. Market yourself properly. A steady pipeline of new patients is far more valuable than wringing more money upfront from the few you already have.

Selling treatment packages might feel like smart business but in reality it’s a shortcut that promotes lazy care, undermines trust, creates unnecessary admin, and distracts you from what really matters – delivering great care. If you want a successful clinic, don’t tie patients into deals. Build trust. Deliver outcomes. Make it easy for people to book, pay, and get better. That’s the kind of clinic patients choose, return to, and recommend to everyone they know.

If you want to improve retention without gimmicks, book a strategy call with HMDG.