Non-NHS services

It is important to understand that many 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 fees charged by GPs contribute towards their costs.

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 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 ensure that information provided to them is true and accurate.

• 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

• 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

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.

The BMA suggest fees that GPs may charge their patients for non-NHS work (ie work not covered under their contract with the NHS) in order to help GPs set their own professional fees.

However, the fees suggested by the BMA are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates we suggest.

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.

Doctors normally charge these fees to the funeral director, who, generally passes on the cost to the family. Doctors are also entitled to charge a mileage allowance, where appropriate.

The fees for cremation forms 4 and 5 (which are agreed with the National Association of Funeral Directors, NAFD, the National Society of Allied and Independent Funeral Directors, SAIF, and Co-operative Funeralcare) are available on our website.

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 healthcare provided either through the NHS, or the private sector, is therefore not subject to VAT.

However, where the purpose of a medical service is not, primarily, the treatment of a patient (for example, the completion of medical insurance reports by a doctor), the Court ruled that this service should be 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.

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 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.

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 (the doctors' regulatory body) or even the Police.

We recommend that GPs tell patients in advance if they will be charged, and what the fee will be.

It is up to individual doctors to decide how much they will charge, but we produce lists of suggested fees which many doctors use. Surgeries often have lists of fees on the waiting room wall based on these suggested fees.

• 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.
• 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.
• Please allow 6-8 weeks for completion, you will be contacted when your form is ready for collection. We may ask you to pay the fee in advance - we have had occasions where a report has not been collected because it is no longer needed. Because the GP has already undertaken the work to complete the report, a fee will still be chargeable in these situations. If you change your mind about your request, please let us know as soon as possible.

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.