Whether or not a practice can charge for a service is a common query we receive in the LMC office. Although sometimes these may require individual consideration, GPs and Practice Managers should be aware of the main guidance.
When Can I Not Charge?
GMS Regulation 24 (but this is the same for all Personal Medical Services contracts whether GMS, PMS or APMS) says that “the contractor either itself or through any other person demand or accept from any of its patients a fee or other remuneration for its own benefit or for the benefit of another person in respect of”:
- Provision of any treatment (even if not under the contract)
- Prescription for any drug, medicine or appliance (except as per Regulation 25)
- A Debt and Mental Health Evidence Form (DMHEF) (including any examination needed to complete the form)
Providing a medical certificate as listed in Schedule 2:
- Relating to incapacity to work, claiming state benefits or proxy to draw pensions (the schedule includes a long list of other legislation related to this)
- Registration of a still birth
- To enable payment relating to a mental disorder
- To establish unfitness for jury service
- Support late application for reinstatement or non-availability to take up civil employment for a member or reserve member of armed forces.
- To enable person to be registered for postal or proxy voting on grounds of physical incapacity.
- Prescription exemption certificate
- Council Tax Exemption for a Severely Mentally Impaired person. TIP: This is one that practices frequently get wrong.
Providing a report to a coroner about one of your deceased patients.
When Can I Charge?
Regulation 25 specifies when a contractor can charge (please read in full via link), and in summary covers:
- From a statutory body for services rendered for the purposes of that body’s statutory functions. TIP: Make sure your practice has a process in place for invoicing the ICB for safeguarding work, including the provision of safeguarding reports and attendance at safeguarding conferences. See LMC guidance regarding how to charge.
- A routine examination and/or opinion for a school, employer or another body who is responsible for the patient’s welfare.
- For treatment where the contractor is providing services as a specialist working for a hospital which is not covered by the contract and given at accommodation for private services or a registered nursing home.
- Section 158 of the Road Traffic Act 1988. TIP: Practices should have a system to identify when a patient is asking for examination after an RTA and they have not been examined before. The chargeable fee is a paltry £21.30 which can normally be reclaimed for the patient’s insurance company.
- Where a patient falsely claims to be on your registered list, the practice can give any necessary treatment and charge a ‘reasonable’ fee.
- Attending and examining a patient at a police station at their request in connection with possible criminal proceedings against them.
- Attending and examining a patient for the purpose of a medical report or certificate at the request of a commercial, educational, not for profit organisation.
- Attending and examining relating to a claim for compensation by the patient.
- Travel vaccinations which are not paid for under the contract (see LLR LMC Guidance).
- Prescribing or providing drugs, medicines or appliances required solely in anticipation of the onset of illness or injury whilst the patient is outside the UK.
- Medical examination regarding
- wearing a seat belt
- creating a report about an RTA or criminal assault
- whether a patient is fit to travel
- Testing a patient’s eyesight not covered by primary ophthalmic services.
- Where the contractor is authorised to dispense drugs, medicines or appliances under Section 126 of the NHS Act 2006.
- For prescribing or providing drugs or medicines for malaria chemoprophylaxis.
- An exemption certificate confirming that the patient should not be tested or vaccinated regarding coronavirus for clinical reasons
What Can I Charge?
The LMC, BMA, or even groups of practices cannot advise practices what to charge for services where a fee has not been negotiated. To do so is price fixing and a breach of competition law.
Practices should consider how long a form or service takes to provide, what staff it requires (e.g. GP, admin, or both) what other costs (excluding premises, but can include an element for consumables, energy and reception time etc). The BMA has produced a fee calculator to help practices to decide what to charge.
For comments or queries, please email the LMC.