Non-NHS Fees

Isn’t the NHS supposed to be free?

The NHS provides most health services to people free of charge, but there are some exceptions. Prescription charges have existed since 1951. Sometimes a charge is made because the service is not covered by the NHS: for example a Medical Report for insurance companies, claim forms for referrals to private care and other letters and forms which require the GP to review a patient’s medical record.

Do GPs have to do non-NHS work for their patients?

With certain limited exceptions, for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients.

Whilst GPs will always attempt to assist their patients with the completion of forms, for example for insurance purposes, they are not required to do such non-NHS work.

Surely the doctor is being paid anyway?

It is important to understand that the East Norwich Medical Partnership GPs are not directly employed by the NHS.

We are self-employed and we have to cover all of our costs – staff, buildings, heating, lighting, etc. – in the same way as any small business. The NHS covers these costs for NHS work, but for not for non-NHS work, therefore the fees we charge contribute towards these costs.

Why does it sometimes take my GP a long time to complete my form?

Time spent completing forms and preparing reports takes GPs away from the medical care of patients. This workload is done on top of a GPs NHS workload.

As GPs we have a very heavy workload and paperwork takes up an increasing amount of our time, so we find we have to take some paperwork home at night and weekends.

I only need the doctor’s signature – what is the problem?

When your doctor signs a certificate or completes a report, it is a condition of remaining on the medical register that they only sign what they know to be true.

In order to complete even the simplest of forms, therefore, your doctor might have to check a patient’s entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the police.

What will I be charged?

We will tell our patients in advance if they will be charged, and what our fee will be.

It is up to individual doctors to decide how much they will charge, but our list of Non-NHS fees are available at reception, in our leaflet for ‘Non-NHS Fees’ and on our website.

These fees are updated regularly.

What is covered by the NHS and what is not?

The Government’s contract with GPs covers medical services to NHS patients, including the provision of ongoing medical treatment.

In recent years, however, more and more organisations have been involving GPs in a whole range of non-medical work.

Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.

Examples of non-NHS services for which GPs can charge their own NHS patients:

  • accident or sickness certificates for insurance purposes
  • school fee and holiday insurance certificates
  • reports for health clubs to certify that patients are fit to exercise

Examples of non-NHS services for which GPs can charge other institutions:

  • life assurance and income protection reports for insurance companies
  • reports for the Department for Work and Pensions (DWP) in connection with disability living allowance and attendance allowance
  • medical reports for local authorities in connection with adoption and fostering

What can I do to help?

  • Not all documents need a signature by a doctor, for example passport applications. You can ask another person in a position of trust to sign such documents free of charge. The GPs at this practice do not sign passport forms.
  • If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.
  • Do not expect your GP to process forms overnight. Urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this will cost more.

What type of report work doesn’t have to be done by my GP?

There is some medical examination and report work that can be done by any doctor, not only a patient’s GP. For this work there are no set or recommended fees which means doctors may set their own fees.

Is it true that the BMA sets fees for non-NHS Work?

The British Medical Association (BMA) suggest fees that GPs may charge their patients for non-NHS work (i.e. work not covered under their contract with the NHS) in order to help GPs set their own professional fees. East Norwich Medical Partnership reviews its fees in line with the BMA Guidance.

Can a fee be charged by a GP for the completion of cremation forms?

It is important to differentiate between death certificates (which must be completed free of charge) and cremation forms.

Cremation forms, unlike death certificates, require doctors to make certain investigations which do not form part of their NHS duties.

A deceased person cannot be cremated until the cause of death is definitely known and properly recorded. Before cremation can take place two certificates need to be signed, one by the GP and one by another doctor.

Cremation form 4 must be, as stated, completed by the registered medical practitioner who attended the deceased during their last illness.

Form 5 must be completed by a registered medical practitioner who is neither a partner nor a relative of the doctor who completed form.

A fee can be charged for the completion of both forms 4 and 5 as this does not form part of a doctor’s NHS duties.

East Norwich Medical Partnership charge these fees to the funeral director.

Can VAT be charged by GPs for some non-NHS services?

Since 1 May 2007, certain medical services have become subject to Value Added Tax (VAT). This follows a European Court of Justice Ruling in 2003, and subsequent changes to VAT rules introduced by HM Revenue & Customs.

The original Court ruling made it clear that, where the main purpose of a medical service is the ‘protection, maintenance or restoration of the health of an individual’ then that service should continue to be exempt from VAT. All heathcare provided either through the NHS, or the private sector, is therefore not subject to VAT.

Such GP reports have been subject to VAT since 1 May 2007. In the UK this applies where a medical practitioner’s income exceeds the VAT registration threshold.

Non-chargeable Certificates

  • Bankruptcy – any individual who is able to give information about a bankrupt may be required to give evidence, for which no charge can be levied
  • Coroners’ Post Mortem under section 19 of the Coroners Act 1988 where the coroner has directed that a post-mortem shall be conducted by the deceased’s GP
  • Council Tax Exemptions – to support a claim by or on behalf of a severely mentally impaired person from exemption from liability to pay council tax or eligibility for a discount in respect of the amount of council tax payable
  • Death certificates
  • Stillbirth Certificates
  • Notification of infectious diseases
  • Paternity Test – services which doctors are not obliged to provide, but when they do, the fee is governed by statute: for example fees for taking samples of blood required in cases of disputed paternity under the Blood Tests (Evidence of Paternity) Regulations.
  • Professional evidence in court
  • To establish unfitness for jury service
  • Statutory certificates for the Department of Work and Pensions

Our list of NHS Fees is currently being updated.