The doctors at Great Ormond Street Hosptial (GOSH) don’t tend to take bloods more than once a year, unless there are clinical indicies that CAH control is not good.  Appointments are generally offered on the NHS six monthly there, although this too can be more often, if once again, there is a problem.  As a private patient, you can of course be seen as regularly as you like and can demand more regular blood tests, although this is more a case of the doctor not considering them necessary than due to cost.  

I do not personally know Dr Ryalls at the Royal Surrey but know that his patients are able to do home 17OHP profiles in between visits, which I think are a pretty good indication of overall control (4 blood spots taken over a 24 hour period).  Unfortunately this facility is not available at GOSH.  If a child is thought to be ’out of control’ though or it is suspected that there is a problem, they will be admitted overnight for full profiling. 

It is difficult to advise but if you have the option of private or NHS cover, if you don’t like one, you should be able to change without any problem to the other!  Obviously every patient is different and I am just giving a general view here as to how both consultants manage patients.  You can always state what you expect and hope your wishes will be met, as both these doctors are known to be pretty reasonable!  They will obviously understand that you expect the same standard of care and monitoring currently received in the US.  Remember you are your childrens advocate and it is up to you to ensure they are well looked after - so don’t be afraid to speak out and obtain a second opinion if the first doctor you see does not meet with your expectations.