Normal in short bursts. Damaging when it never switches off.
Assessed and treated by a GMC-registered GP
Prescriptions, sick notes and referral letters included
A written treatment plan after every appointment
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
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Stress is the body's response to demand. In short bursts it is useful — adrenaline and cortisol sharpen attention, raise heart rate and mobilise energy, which is exactly what you want when something needs dealing with.
The problem is when the response does not switch off. A system designed for short emergencies, running continuously for months, produces real physical consequences: raised blood pressure, disturbed sleep, gut symptoms, skin flares, headaches, and a measurably increased cardiovascular risk.
That is worth stating plainly, because the physical symptoms of stress are frequently dismissed — by patients and clinicians — as "just stress", as though that made them imaginary. The chest tightness, the IBS, the palpitations and the exhaustion are physiological events, not a failure of perspective.
Two distinctions are worth drawing:
Stress versus burnout. Stress is too much — urgency, over-engagement, a system running hot. Burnout is nothing left — detachment, emptiness, blunting.
Stress versus anxiety disorder. Stress is proportionate to an identifiable pressure and eases when that pressure lifts. Anxiety persists, generalises, and continues after the trigger has gone.
The same pressure affects people differently, and it is not about toughness:
Sustained cortisol and adrenaline raise blood pressure, promote abdominal fat storage, worsen blood sugar control, suppress immune function and increase inflammation. Chronic stress is an independent cardiovascular risk factor, which is the reason it is worth treating as a medical matter rather than a mood.
"Adrenal fatigue" is not a recognised medical condition. The theory — that chronic stress exhausts the adrenal glands — has been examined and is not supported by evidence. Saliva cortisol tests sold to diagnose it are not clinically validated, and the supplements sold alongside treat nothing. Genuine adrenal insufficiency is a real and serious condition, diagnosed quite differently, and we will test for it where the picture warrants.
Stress is assessed clinically. The purpose of investigation is to make sure the physical symptoms are not something else — because attributing symptoms to stress without checking is exactly how conditions get missed.
Saliva cortisol testing for "adrenal fatigue" — not clinically validated, and the results do not guide any legitimate treatment. If a service has offered you one, that is worth questioning.
Chest pain, palpitations with fainting, unexplained weight loss, and persistent gut symptoms with bleeding are assessed as symptoms, not attributed to stress — however stressed you are.
The most useful early step is dividing the pressures into those you can influence and those you cannot. Problem-focused effort works for the first group; emotion-focused coping is the right tool for the second, and applying either to the wrong category is exhausting and futile.
Twenty minutes is generally enough to do that properly, which a ten-minute appointment is not.
Regular physical activity reduces cortisol reactivity and improves mood and sleep, with better evidence than any other self-directed measure. It does not need to be much; consistency beats intensity.
Stress disrupts sleep and poor sleep amplifies stress, which is a loop worth breaking early. Where insomnia has become established, CBT for insomnia is more effective than anything else — and we do not prescribe sleeping tablets remotely.
Worth an honest conversation. Alcohol reduces anxiety for a couple of hours and then produces rebound anxiety the following day, along with fragmented sleep. People frequently arrive believing stress is causing their poor sleep and low mood, when the drinking they took up to manage it has become the larger factor. No lecture attached — but it is worth looking at.
You can self-refer to NHS Talking Therapies free, without a GP. CBT is effective for stress-related difficulty, and stress management and problem-solving approaches have good evidence.
A fit note where time away is genuinely needed; a supporting letter for workplace adjustments; and referral where appropriate. Employers have a legal duty to assess and manage work-related stress, which is worth knowing before assuming nothing can change.
Seek urgent help now — call 999, or the Samaritans on 116 123, free at any hour — if:
Call 999 for chest pain with sweating, nausea, breathlessness, or pain spreading to the jaw or arm. Do not assume chest pain is stress — being under pressure does not protect you from heart disease, and stress-related chest tightness and cardiac pain can feel identical.
Seek prompt assessment for:
Book a routine consultation if:
Breathe out for longer than you breathe in — in for four, out for six. The long out-breath activates the parasympathetic system directly; it is a physiological effect rather than a distraction, and it works within a minute or two.
Moderate evidence for stress and anxiety, and worth trying — but it is not a substitute for reducing the actual demand, and it will not fix an unmanageable situation. Free NHS-recommended apps exist; there is no need to pay.
There is no medication for stress, and that is worth saying first — because a great deal of what is sold for it does nothing.
What has evidence is free. NHS Talking Therapies takes self-referrals without a GP appointment, and CBT-based approaches work. Regular physical activity has a genuine and reproducible effect on stress and mood. Sleep, alcohol reduction and structured problem-solving do more than any supplement.
Your NHS GP will help free, including with a fit note where work is the problem.
Where a private consultation genuinely helps is separating stress from something else. Persistent stress symptoms are frequently depression, an anxiety disorder, burnout, or a physical condition — an overactive thyroid and anaemia both present as feeling wired and exhausted. That distinction changes what helps.
The other genuinely useful output is documentation. A letter for an employer, or an occupational health letter supporting adjustments, is often more use than anything prescribed — and is a legitimate reason to pay.
What we will not do is prescribe benzodiazepines or z-drugs for stress. They cause dependence quickly, and they do not address anything.
Where money is wasted: cortisol saliva testing, “adrenal fatigue” panels — which is not a recognised diagnosis — and stress supplement protocols.
Stress is not a clinical diagnosis in itself, and there is no NICE guideline for it as such. Assessment is therefore about identifying what underlies it.
NICE NG222, Depression in adults, and NICE CG113, Generalised anxiety disorder and panic disorder, apply where symptoms meet diagnostic criteria, and both recommend psychological therapy as a first-line option.
NICE NG212, Mental wellbeing at work, covers workplace factors, organisational interventions and support for employees experiencing work-related stress — relevant where the source is occupational.
NICE guidance on physical activity supports exercise for mental wellbeing.
NICE and the Society for Endocrinology do not recognise “adrenal fatigue” as a diagnosis, and salivary cortisol testing has no validated role in assessing everyday stress — the basis for the position above.
Yes — this is measurable physiology rather than a figure of speech. Sustained cortisol and adrenaline raise blood pressure, worsen blood sugar control, suppress immune function and increase inflammation. Chronic stress is an independent cardiovascular risk factor. The gut symptoms, skin flares and headaches are real consequences, not imagination.
Almost certainly not. "Adrenal fatigue" is not a recognised condition, and the saliva cortisol tests sold to diagnose it are not clinically validated. The supplements sold alongside them treat nothing. Genuine adrenal insufficiency is a real and serious condition diagnosed quite differently, and we will test properly where the clinical picture warrants it.
Stress is proportionate to an identifiable pressure and eases when it lifts. Anxiety persists, generalises and continues after the trigger has gone. If you are worrying about everything rather than the specific thing, and it has not settled with the situation, it has probably moved beyond stress — which is treatable in its own right.
No, and the difference is useful. Stress is having too much — urgency, over-engagement. Burnout is having nothing left — detachment, emptiness, cynicism. Burnout is also specifically occupational. They need different responses, and stress-management techniques applied to burnout tend not to work.
For about two hours, then it works against you. Alcohol fragments the second half of the night and produces rebound anxiety the following day, so the net effect over a week is more stress rather than less. It is the commonest coping response and the one that most reliably backfires.
Not benzodiazepines — they help briefly, tolerance develops within weeks, and they address nothing. If stress has developed into depression or an anxiety disorder, medication may well be appropriate for that. Otherwise the effective interventions are exercise, sleep, therapy and changing what can be changed.
It has moderate evidence and is worth trying. What it will not do is fix an unmanageable workload or an impossible situation — and being told to be more mindful about circumstances that need to change is understandably irritating. Free NHS-recommended apps exist, so there is no need to pay for one.
Quite possibly, particularly in your forties or fifties. Falling oestrogen reduces stress tolerance, disrupts sleep and increases irritability, and a great deal of what gets labelled stress at that age is perimenopause. It is worth raising, because treating that may change how everything else feels.
August 23, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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