Frequently asked questions: why do GPs sometimes charge fees for non-NHS work?
Isn't the NHS supposed to be free?
The National Health Service provides health care to most people free of charge, but there are exceptions. The NHS does not employ GPs. It has a contract with them to provide NHS general medical services for their patients. Sometimes, however, GPs are asked to provide additional services, which fall outside their contract with the NHS, and in these circumstances they are entitled to make a reasonable charge for providing them. The British Medical Association values GP time spent doing non-NHS work at £186 per hour.
Surely the doctor is being paid anyway?
It is impotant 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.
What is covered by the NHS and what is not?
The Government's contract with GPs covers medical services to NHS patients. 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 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
Is it true that the BMA sets fees for non-NHS work?
The BMA suggests fees for non-NHS work which is not covered under a GP’s NHS contract, to help GPs set their own professional fees. However, these fees are guidelines only, not recommendations, and a doctor is not obliged to charge the rates suggested.
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 work late at night and at weekends. The GPs will aim to complete forms as quickly as possible; however this depends greatly on the demand at that time.
I only need the doctor's signature. What’s taking them so long?
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.
If you are a new patient we may not have your medical records so the doctor must wait for these before completing the form.
What will I be charged?
It is up to the individual surgery to decide how much to charge. Charges for these services may vary as different organisations may have different requirements. In order to be fair to all patients, there are no exceptions to the charges. The GP will decide what the charge will be and all fees must be paid in advance of work being carried out by the GP.
Do not expect the GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this may cost more. Please allow at least 2-4 weeks for completion of any requests - this may take longer if the GP you requested is on holiday or the demand is particularly high.
Please note that all forms or letters are completed at the GP’s discretion.