What should a practice pay in card fees?

Short answer: most UK practices should be paying somewhere between 0.6% and 1.4% of card turnover, all in. If your effective rate is above about 1.6% you are almost certainly overpaying, and if it is above 2% something is structurally wrong with your setup rather than your negotiating.

That range is wide because the honest answer depends on your mix — a practice taking mostly UK consumer debit cards sits near the bottom, one taking a lot of commercial or international cards sits nearer the top. But the range is narrow enough to be useful, and most owners have never had a number to compare against at all.

The rest of this is how to work out your own figure, and what to do if it lands on the wrong side of that range.

Why nobody knows their own rate

When you signed up, you were quoted a rate. It was probably something like 0.35% plus 2p, and it probably felt fine.

That number describes one slice of your transactions, usually UK consumer debit, presented in person, on a card that behaved itself. Everything else — credit cards, business cards, cards issued outside the UK, contactless above the limit, keyed-in payments, refunds — is priced differently, and the differences are not small.

Then there is everything that isn't a percentage at all: terminal rental, PCI compliance charges, a minimum monthly service charge, an authorisation fee per transaction, a chargeback handling fee, sometimes a "non-secure transaction" premium. Individually they look trivial. Collectively, in a practice doing modest volume with a high average transaction value, they can be a third of what you pay.

So the quoted rate is real, and it is also not what you pay. The number that matters is the effective rate: everything the processor took, divided by everything you processed.

Work out your effective rate

You need one recent monthly statement. Then:

Effective rate = total charges ÷ total card turnover × 100

Two rules make this meaningful:

1. Total charges means everything. Every percentage line, every per-transaction fee, terminal rental, PCI charges, monthly minimums, the lot. If it left your account and went to the processor, it counts. The most common mistake is counting only the interchange lines, which flatters the answer.
2. Use gross turnover, not net of refunds, and use a normal month. A quiet August will overstate your rate because the fixed costs spread across less volume.

That single percentage is the number to compare, negotiate on, and re-check annually. It is also the only number worth quoting when you ask another provider for a price.

What the number means

Roughly, on a typical private practice mix:

• Under 1% — you are on a good rate. Worth re-checking annually, not worth switching over.
• 1% to 1.4% — normal. There may be something available, but it is a negotiation, not an emergency.
• 1.4% to 1.8% — you are paying more than you need to. Usually fixable without changing provider.
• Above 1.8% — something is structurally wrong. Common causes are a legacy blended rate that was never revisited, a terminal lease bundled into the processing contract, or a package sold on convenience rather than price.

Two caveats worth stating. A practice with a very high average transaction value — implant work, a course of aesthetic treatment, capital equipment — will have a lower effective rate for the same deal, because the per-transaction fees matter less. And a practice taking a lot of international cards will run higher through no fault of anyone's.

The five lines to check on your statement

1. The non-qualifying or standard rate. This is where transactions land when they do not meet the criteria for your headline rate. If a large share of your volume is landing here, the headline rate is decorative.
2. Terminal rental. Often £20–£40 per terminal per month, frequently on a separate lease with its own term, sometimes running years after the processing contract was renegotiated.
3. PCI compliance charges. A monthly fee, plus a non-compliance penalty if you have never completed the questionnaire. The penalty is avoidable and a surprising number of practices pay it indefinitely.
4. Minimum monthly service charge. If your volume dips below the threshold, you pay the difference. Seasonal practices pay this without noticing.
5. Authorisation fees. A few pence per transaction. In a practice with high volume and low average value, this is the line that quietly dominates.

What to do about it

If your effective rate is above the range, you have three options in order of effort:

Ask your current provider to review it. The cheapest fix, and it works more often than people expect, because retention is cheaper than acquisition. Come with your effective rate, not a vague sense of dissatisfaction.

Separate the terminal from the processing. Bundled hardware contracts are where a lot of avoidable cost hides, and they frequently outlast the deal they arrived with.

Move. Worth it when the gap is large or the relationship has stopped being a relationship. Get the quote priced against your actual statement, not against a hypothetical mix.

A note on how I know

I run a clinic as well as SupplyIndex, and I am a Chartered Accountant, and I still let this run unchecked for years. When I finally sat down with our own statement properly, we were overpaying by about £6,000 a year. Nothing exotic had happened — the rate was set when the account opened and nobody revisited it, which is exactly how it goes.

If you want the arithmetic done for you, send me a recent statement and I will tell you your effective rate and where it sits. No charge, and if you are already on a good rate I will tell you that instead — which is worth knowing too.