Concierge rehabilitation · London
Long COVID rehab clinic - London.
A specialist-led multidisciplinary pathway for people with symptoms persisting more than 12 weeks after SARS-CoV-2 infection. PEM-aware pacing, PoTS management, breathing rehab and cognitive rehab, delivered by a named physician, physio, OT, dietitian and psychologist.
What long COVID is
A multisystem, heterogenous condition after SARS-CoV-2.
Post-acute sequelae of SARS-CoV-2 (PASC) describes symptoms that persist more than 12 weeks after acute infection and are not explained by an alternative diagnosis. Presentations vary widely.
- Profound fatigue and post-exertional malaise (PEM)
- Breathlessness and dysfunctional breathing
- Brain fog and executive dysfunction
- PoTS and other dysautonomia
- GI symptoms and food intolerance
- Chest pain, palpitations and headache
Assessment
Specialist-led MDT, not a single-clinician view.
Assessment is delivered by a physician, physiotherapist, occupational therapist, dietitian and psychologist working together. The first job is to exclude alternative diagnoses that could explain your symptoms.
- Cardiac workup - ECG, echocardiogram and CPEX where indicated to rule out myocarditis, ischaemia and deconditioning contributions.
- Autonomic workup - active stand or tilt-table test for PoTS and orthostatic intolerance.
- Sleep study - to identify obstructive sleep apnoea and non-restorative sleep patterns.
- Bloods and imaging - to exclude thyroid, iron, B12, vitamin D, autoimmune and post-viral inflammatory drivers.
- Respiratory review - lung function and CT chest where breathlessness dominates.
- Red-flag review - chest pain at rest, syncope, focal neurology and haemoptysis are investigated urgently, not rehabilitated.
PEM and PoTS-aware treatment
The features that make a long COVID service safe.
The right service is built around pacing, not pushing. Post-exertional malaise is the cornerstone symptom, and it changes what safe rehab looks like.
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PEM-aware pacing
Post-exertional malaise is the cornerstone symptom. We use symptom-titrated pacing, not graded exercise, in line with NICE NG206 (2024 update).
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PoTS workup and management
Active stand or tilt-table testing, fluid and salt loading, compression, and where indicated ivabradine or a low-dose beta-blocker.
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Breathing pattern rehab
Papworth-style retraining for dysfunctional breathing. Aerobic reconditioning only when PEM is absent and safe.
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Cognitive rehab for brain fog
Occupational therapy strategies, screen hygiene, sleep, and structured cognitive tasks pitched below the symptom threshold.
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Dysautonomia and GI care
Dietitian-led review for GI symptoms, small frequent meals, and autonomic support alongside cardiology and neurology input.
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Psychology, not psychologising
Adjustment support and anxiety care for a physical illness. Never a substitute for medical assessment.
Interventions
What is actually in the programme.
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Occupational therapy pacing programme with activity diary and energy envelope
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Breathing retraining (Papworth method) for dysfunctional breathing pattern
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Dietitian review for GI symptoms, histamine intolerance and hydration
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Psychology for adjustment, anxiety and low mood alongside medical care
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Cognitive rehabilitation for brain fog and executive dysfunction
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Low-dose naltrexone (LDN) in carefully selected patients
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Sleep hygiene, non-restorative sleep review, referral for sleep study
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PoTS pharmacology: ivabradine, low-dose beta-blocker, midodrine or fludrocortisone
What NOT to do
Where long COVID rehab most often goes wrong.
- Aggressive graded exercise therapy (GET) is not recommended in people with PEM. NICE NG206 (2024 update) warns of potential harm.
- Do not push through symptoms. Post-exertional malaise can worsen for days after over-exertion.
- Do not rely on aerobic reconditioning alone when PoTS or PEM is present.
- Do not assume symptoms are psychological before excluding cardiac, respiratory and autonomic causes.
Programme
A 12 to 24 week structured pathway.
The first 12 weeks focus on assessment, pacing, breathing rehab and PoTS management. The next 12 are graded reintroduction of activity, only where PEM has settled.
Cost
Indicative private fees.
| Item | Indicative range | Notes |
|---|---|---|
| Initial specialist-led MDT assessment | £550 – £950 | 90 – 120 min |
| Follow-up per specialist (physician, physio, OT, psychology) | £150 – £280 | 30 – 45 min |
| Tilt-table test or active stand with autonomic panel | £450 – £950 | Cardiology day case |
| CPEX / CPET (with PEM safeguards) | £550 – £850 | Only when appropriate |
| Echocardiogram and ECG | £280 – £450 | Same visit |
| Sleep study (home or in-lab) | £350 – £950 | 1 night |
| 12-week structured rehabilitation programme | £2,400 – £4,800 | MDT-led |
Where you can be seen
Experienced London centres.
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Cleveland Clinic London – Long COVID Clinic
MDT model with physician, physio, OT, psychology and dietitian on one pathway.
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HCA Wellington – Long COVID service
St John's Wood site with rapid cardiology, respiratory and autonomic workup.
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Chelsea and Westminster Private Post-COVID
Established post-COVID pathway with strong respiratory and rehab input.
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National Hospital Queen Square (Private Patients)
For complex autonomic dysfunction and neurology-heavy presentations.
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Private PoTS specialists via PoTS UK
Named cardiologists and neurologists experienced in dysautonomia care.
Related
Explore adjacent care.
Frequently asked
Common questions about long COVID rehab.
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What is long COVID?
Long COVID, or post-acute sequelae of SARS-CoV-2, describes symptoms persisting for more than 12 weeks after acute infection that are not explained by another diagnosis. Presentation is heterogenous and can include fatigue, post-exertional malaise, breathlessness, brain fog, PoTS, GI symptoms, chest pain and headache.
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Why not graded exercise therapy?
NICE guidance NG206 (2024 update) advises against fixed, incremental graded exercise therapy for people with post-exertional malaise because it can worsen symptoms. Symptom-titrated pacing, staying within an energy envelope, is preferred.
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How do you diagnose PoTS?
A structured active stand or tilt-table test with heart rate and blood pressure monitoring, alongside symptom review. We look for a sustained heart rate rise on standing with typical symptoms, having excluded dehydration, deconditioning and cardiac causes.
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How long is the programme?
A typical structured pathway runs for 12 to 24 weeks. The first 12 weeks focus on assessment, pacing, breathing rehab and PoTS management. The next 12 are graded reintroduction of activity, only where PEM has settled.
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What does the initial MDT cost?
Initial specialist-led MDT assessment is usually £550 to £950. Follow-ups with individual specialists are £150 to £280 each. A full 12-week programme is typically £2,400 to £4,800.
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Where can I be seen privately in London?
Cleveland Clinic London, HCA Wellington, Chelsea and Westminster Private, National Hospital Queen Square (Private Patients) and a small group of private PoTS specialists listed via PoTS UK all run experienced services.
Speak to our team
Ready for a long COVID pathway that respects pacing over pushing?
Send us your symptom timeline and prior investigations. Within one working day we come back with two or three MDT options, indicative costs and expected timelines.