Services which are outwith the NHS Contract
The National Health Service provides most healthcare to the majority of people free of charge, but there are exceptions. GPs are self-employed and are contracted to provide NHS general medical services for their patients.
Sometimes, GPs are asked to provide additional services which fall outside their contract and in these circumstances, they are entitled to make a reasonable charge for providing them.
Your Questions Answered
Isn’t the NHS supposed to be free?
The National Health Service provides most healthcare to the majority people free of charge, but there are exceptions: for example, medical reports for insurance companies.
Surely the Doctor is being paid anyway?
It is important to understand that GPs are not employed by the NHS, they are self-employed and they have to cover their costs – staff, buildings, heating, lighting, etc – in the same way as any small business. The NHS covers these costs for NHS work, but for non-NHS work the fee has to cover the Doctor’s costs.
In recent years, more and more organisations have been involving Doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked to do non-medical work is because they are in a position of trust in the community, or because an insurance company or employer wants to be sure that information provided is true and accurate.
Examples of non-NHS services for which GPs can charge their NHS patients are:
- accident/sickness insurance certificates
- certain travel vaccinations
- private medical insurance reports
- statements of fact relating to general health e.g. for children’s dance classes
- Letters requested by, or on behalf of, the patient
- Holiday cancellation claim forms
- Referral for private care forms
Examples of non-NHS services for which GPs can charge other institutions are:
- medical reports for an insurance company
- some reports for the DSS/Benefits Agency
- examinations of occupational health
Why does it sometimes take my GP a long time to complete my form?
Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload – the majority work up to 70 hours a week – and paperwork takes up an increasing amount of their time, so many GPs find they have to take some paperwork home at night and weekends.
I only need the Doctor’s signature – what is the problem?
When a 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, the Doctor might have to check the patient’s entire medical record. Carelessness or an inaccurate report can have serious consequences for the Doctor with the General Medical Council or even the Police.
What can I do to help?
If you have several forms requiring completion, present them all at once, do not expect your GP to process forms overnight.
Examples of Non-NHS Services include the following:
- Medicals for pre-employment, sports and driving requirements (HGV, PSV etc.)
- Insurance Claim Forms
- Prescriptions for taking medication abroad
- Private Sick Notes
- Vaccination Certificates
The fees charged are based on the British Medical Association (BMA) suggested scales.
| Insurance Companies | |
| a) GP report for insurance applicants | £100.00 |
| b) GP supplementary reports | £30.00 |
| c) Medical examinations undertaken on a GP’s own patient | £110.00 |
| Note: Patients have a right to see the report before it is sent to the insurance company. If a request is made, the insurance company should inform the GP, and the patient has 21 days to arrange to see it. | |
| Note: When an applicant fails to keep a pre-arranged appointment, 50 per cent of the fee should be paid by the insurance company. | |
| Certificates without examination | |
| a) Straightforward certificates of fact | £20.00 |
| More complex certificates | £60.00 |
| Private sick note (incapacity certificate), required by patient for presentation to an employer (except those that the doctor is obliged to provide for statutory sick pay (SSP) purposes) | £15.00 |
| Accident/sickness insurance certificate – short certificate of incapacity without examination for patient to claim under accident/sickness insurance | £60.00 |
| Freedom from infection certificate, eg for school, travel or employment | £15.00 |
| Validation of private medical insurance (PMI) claim form, to support a claim for benefit in connection with private medical insurance, or completion of a ‘pre-treatment’ form | a/b |
| Health club – brief written report to certify that a patient is fit for exercise | £15.00 |
| Passport Forms | £25.00 |
| Work in surgery | |
| a) Extract from records | £56.00 |
| b) Report on a pro forma, no examination (eg 20 minutes) | £110.00 |
| c) Written report without examination, providing a detailed opinion and statement on the condition of the patient (eg 30 minutes) | £110.00 |
| d) Comprehensive clinical examination including report, certificate, or completion of necessary forms (eg 45 minutes) | £150.00 |
| Accident/sickness insurance – to support a claim for payment of benefit under accident/sickness insurance policy | £60.00 |
| Employment – for pre-employment or on an employee, requested by an employer Note: The exception is for local authority employees which are covered |
|
| Miscellaneous Fees | |
| Completion of medical certificate CP3 of the Court of Protection with examination | £138.00 |
| Completion of medical certificate CP3 of the Court of Protection without examination |
£70.00 |
| Serving notice of the Court of Protection (on form CP7) | £70.00 |
| Completion of childminder health form | £90.00 |
| Medical examination of prospective NHS employee – including report and opinion |
£140.00 |
| Report and opinon only of prospective NHS employee | £110.00 |
| Housing Support Letter | £5.00 |
| Fit to attend school/university (no examination) | £15.00 |
| Fit to attend school/university (examination) | £20.00 |
| Work for local authorities | |
| Children in care, adoption & fostering Examinations and reports on children committed, or about to be committed, to the care of a local authority, or received or about to be received into care by a local authority, or about to be fostered |
|
| Initial examination | £75.00 |
| Subsequent examination by the same doctor, or partner, assistant or locum | £25.00 |
| Freedom from infection certificate only | £25.00 |
| Examinations and reports in a form recommended by the British Association for Adoption and Fostering (BAAF) and included in the collaborative arrangements. | |
| Forms C, D, YP or AME (detailed medical examinations to report on child | |
| Forms C, D, YP or AME (detailed medical examinations to report on child | £90.00 |
| Form AH – health assessment on prospective carer | £90.00 |
| Form AH – health assessment on prospective carer | £90.00 |
| Form AH2 – update review from GP records | £90.00 |
| Form IHA – initial health assessment for looked after children | £90.00 |
| Form M & B – obstetric/neo natal report | £90.00 |
| Central Government Departments & Agencies | |
| Criminal injuries compensation authority – GP Report on pro forma | £45.00 |
| Employment Medicals & Reports | |
| HGV Medical – if paid by the patient | £90.00 |
| HGV Medical – if paid by the employer | £165.00 |
| PSV Medical – if paid by the patient | £90.00 |
| PSV Medical – if paid by the patient | £90.00 |
| Taxi Medical – if paid by the patient | £80.00 |
| Taxi Medical – if paid by the employer | £165.00 |