The great British travel testing debate

Tamara Hinson attempts to find out who’s swindling who when it comes to the ridiculously high cost of PCR tests

With mass travel now a possibility, holidaymakers need to do more than just pack their bag before they head off (Getty/iStock)

The great British getaway is now up and running, with international travel finally allowed to restart. Any travellers booked to fly to Portugal, the sole mainstream holiday destination from the 12-strong “green list”, need to present a negative polymerase chain reaction (PCR) test, taken within 72 hours, on arrival.

Attention then turns to testing. Travellers booked to fly out will need to organise a PCR test, and unlike the budget flights of the past two decades, they don’t come cheap. Recent figures from Which? found that a family of four could face a bill of £1,500 for testing for a holiday to Greece.

It didn’t take long for providers to start cutting costs. Many pharmacies – including Superdrug, Boots and Lloyds Pharmacy – as well as mail order test providers such as Randox and C19 Testing have slashed the cost of their tests, in order to appeal to holidaymakers who baulk at the idea of spending an extra £300 on tests for a weekend in the sun.

From 17 May, international travel became legal again, under a “traffic light” system that has many caveats, many of them related to testing. Travel to all countries, whether green, amber or red, will require testing to come back to the UK (all arrivals need to present a negative lateral flow test and a negative PCR test within two days of arrival, while amber and red arrivals require an additional day eight test). Added to that, many countries demand a negative PCR test for entry.

Randox, which owns one of the UK’s biggest laboratories and processes tests for numerous clinics and tour operators, recently partnered with several airlines to offer a 50 per cent discount on PCR tests, originally priced at £120. Tui now offers £20 package tests with Chromatics (although unlike Randox’s tests, these are subsidised by the cost of the holiday which you’ll have to book first).

The pharmacy prices also differ wildly. Boots charges £65 for an at-home test and £99 for an in-store test; Lloyds Pharmacy charges £119 for an at-home test and £150 in the clinic; while Superdrug’s in-store test will set you back £120. Both in-store and at-home tests will take at least 24 hours to process.

One group of testing providers yet to succumb to the slash-fest is the clinics, which have charged extortionate fees from the outset. For the most exclusive ones, a revolving door of monied clientele means there’s less impetus to reduce costs. After all, if there’s one way to take the shine off a billionaire’s last-minute jaunt to a far-flung second home, it’s the prospect of queuing in line to get swabbed in Superdrug.

Not that the process of PCR testing is cheap – if a provider is simply a clinic, the clinic will pay a fee to the laboratory where samples are processed. One services director at a leading PCR test provider told The Independent that their laboratory processing fees range from £65 to £125 per test, depending on turnaround times.

Whether it’s deflection or genuine frustration, doctors at many of the clinics The Independent contacted were quick to blame the government. In December 2020, the Department of Health and Social Care (DHSC) decreed that clinics and laboratories conducting and processing PCR tests have to go through Ukas (the United Kingdom Accreditation Service) – a private company appointed by the government to assess and accredit organisations which provide services including testing, inspection and calibration. Any clinic offering on-site Covid testing which doesn’t have this accreditation from 30 June will fall foul of the Coronavirus Health Act.

Almost everyone The Independent spoke to at clinics which offer PCR testing voiced the belief that Ukas accreditation is a prohibitively expensive process, and many claimed it was unnecessary. “We were already CQC (Care Quality Commission) and GMC (General Medical Council) registered,” says Dr Laurence Gerlis, chief executive officer and lead clinician at SameDayDoctor, which has clinics in London and Manchester, and offers a range of PCR tests. “The Ukas requirements, imposed by the DHSC, cost thousands of pounds upfront for registration, training, reporting and inspection. Ukas accreditation is meant for lab registration. We’re not a lab, but we now have to register as one just to put a swab into someone’s nose.”

Dr Gerlis believes that much of the public fury relating to PCR test pricing stems from a lack of awareness about the clinic’s costs, such as Ukas certification and lab fees. “Quite frankly, the whole PCR testing process is full of aggravation,” he says. “For example, for the day two and eight tests, we have to report daily to DHSC. Dedicated staff are needed for this and the paperwork is overwhelming. Private clinics are being blamed for ridiculous rules which have been brought in by the DHSC without consideration for the consequences. Ukas is a private organisation. We’re being exploited and the government is encouraging it,” says Dr Gerlis, who revealed a £7,647 assessment invoice sent to him by Ukas on 12 May.

Another pharmacist at one of the UK’s biggest PCR test providers echoed Dr Gerlis’s statement that the costly accreditation had been initially drawn up with laboratories in mind. “The ISO standards were designed for laboratory testing regimes, not small independent healthcare facilities, hence the huge burden, both financial and manpower-related, that is being experienced across the sector. Regulation is a good thing, but it should be proportional and well thought out. Neither is evident here.”

But it’s hard to feel too much sympathy – SameDayDoctor’s fit-to-fly PCR test costs £195 for a 24-hour turnaround service, and considering that there’s no shortage of providers offering similar in-clinic tests for under £130, businesses offering tests for £190 or over (and there are plenty of them) are surely still making a tidy profit. The strongest voices of dissent came from doctors at the most exclusive clinics, and one can’t help but wonder if some are now regretting an initial keenness to jump on a PCR-testing bandwagon which appeared to be a lucrative opportunity. These clinics’ exclusivity has perhaps been their undoing; they must meet the same requirements as high street testing providers, but are less able to offset unexpected costs because they’re selling fewer tests.

Portugal is the only mainstream holiday destination on the government’s ‘green list’ (Getty/iStock)

Surely it was inevitable, given the pace at which the virus and testing requirements evolved that new criteria would be introduced at short notice? The Department of Health and Social Care insists that the accreditation is essential.

“As part of the quality assurance process for all Covid-19 tests, private test providers must obtain Ukas accreditation to ensure tests are high quality and meet a robust set of standards,” said a government spokesperson. Additionally, Ukas points out that costs vary depending on capacity. “The costs are hard to predict as there are multiple dependencies, such as the scope of accreditation being sought, organisation size and how comprehensive the Quality Management System (QMS) is. We would expect that the fees would be lower for small test providers.”

In an age when people will be sticking pre-travel PCR swabs down their throats on a regular basis, isn’t it only right that new regulations are created as more clinics segue into PCR testing? And even given the additional costs relating to Ukas accreditation, there’s still a huge price discrepancy.

Dr Gerlis argues that his £195 pre-travel test fee is fair, but at London’s Harley Street Health Centre, a pre-travel PCR test (with next-day results) costs £135. Ironically, Harley Street Health Centre managing director Alya Shakir is one of the few to admit that customers using certain private clinics inevitably pay extra for the more desirable setting. “Costs are also determined by volumes – in a private setting, we limit the number of patients seen to keep everyone safe, and this has a direct impact on cost per patient,” says Ms Shakir.

Almost all of the doctors at clinics charging around the £200 sum for PCR tests with standard 48-hour turnarounds gave additional justification for their fees by pointing out that tests are carried out by highly trained practitioners in fully licensed, government-approved clinics. Which is great, but test providers such as Superdrug are required to have Ukas accreditation and – believe it or not – the person poking a swab up your nose won’t be a shelf stacker moonlighting as a medical professional, but someone with similar credentials to those working in private clinics.

Either way, a key takeaway (and perhaps one upside of the Ukas accreditation) seems to be this: when it comes to PCR tests, both the test and process will almost always be the same whether you pay £60 or £160. The labs used by the most expensive testing providers will also be processing tests for ones charging half the price.

Companies think they can get away with a certain price and they charge it

Professor Stephen Bustin

While the jury’s out on who’s to blame for the high cost of PCR tests, Professor Stephen Bustin, an expert on quantitative PCR at Anglia Ruskin University, believes – despite the recent discounting frenzy – almost all PCR tests are still overpriced. “In my opinion this has a lot to do with greed,” says Professor Bustin. “Companies think they can get away with a certain price and they charge it. The technology used has been around since the 1990s. RNA extraction robots and PCR instruments cost anywhere from £5 to £25,000 depending on the model, and most instruments can run 96 tests at a time.”

It’s hard not to feel deflated when he reveals what he considers a fair price. “For us, in a small academic lab, it costs around £5 to run a PCR test,” says Professor Bustin. “But we don’t buy ingredients in bulk, so that price could be lower. In my opinion a fair price – one which reflects ingredient costs as well as the infrastructure required – would be around about £20.”

However, it’s important to bear in mind that clinics without their own labs will pay a fee to the laboratory they use, and labs which process thousands of tests a day will use have different, more expensive technology to the kit used by ones which process a handful every week. Randox is one example. “Over the past year, Randox has developed the largest Covid-19 testing laboratories in the country,” says a Randox spokesperson. “The current capacity is over 500,000 tests per day, and we continue to invest in and expand that.”

Randox is one of the UK’s leading test providers (Supplied)

Despite this, it’s impossible to ignore the fact that, in many European countries, PCR tests can be purchased for around £20, which is the price suggested by Professor Bustin. It’s true that – unlike in the UK – EU countries don’t charge VAT on PCR tests, but this doesn’t explain the the price gap.

While writing this piece, The Independent heard from travellers who paid £25 for a PCR test in Istanbul, Turkey; £30 for one in Tbilisi, Georgia; and £80 for one (with same day results) at a private hospital in Sofia, Bulgaria. Recent analysis by Abta and the Airport Operators Association revealed that, on average, in the UK a pre-departure PCR test costs £128 and that in eight European destinations, the average cost for a pre-departure PCR test is £62. And they’re getting cheaper. In May 2021, the Balearic Islands’ government approved legislation dictating that the maximum price for a PCR test will be €75 (£65), reducing potential costs racked up by travellers returning to the UK.

It seems that change is required on all fronts. Government legislation could drastically reduce the cost of PCR tests and provide more consistency, while forcing the clinics which charge extortionate sums to reduce their fees. Surely Ukas has a part to play, too. Few would argue that industry-wide certification isn’t essential, although it seems odd that Ukas reaps such huge financial rewards from the associated costs, without passing any benefits onto the travellers paying for the tests.

Our advice? Shop around. Ensure your tester is on the government’s approved list, which means it’s going through – or has gone through – Ukas’s accreditation process. You’ll find that list here. Consider cutting out the middleman and self-test with a company like Randox. We’ve all heard horror stories about inconclusive results from a test taken hours before a flight, but in reality, they’re few and far between. The Independent spoke to someone who oversees regular testing (for travel purposes) of employees, many of whom need to test daily, at a huge company in southeast England. The employees self-test, and she estimates that there have been under 10 inconclusive results in the past year. If you decide to get tested at a clinic, read the small print. While many have disclaimers absolving them from responsibility in the event of inconclusive results, others, including Boots, offer a refund.

And finally, when it comes to the actual testing, take your time and don’t be squeamish. “Follow the instructions and don’t be afraid of gagging,” says Nick Burnett at C19 Testing, one of the leading providers of pre-travel Covid tests. “If you gag, you’re doing it right!”