Patient Charges

Why do GPs charge fees – Your questions answered

Isn't the NHS supposed to be free?

The National Health Service provides most health care to most people free of charge, but there are exceptions. Prescription charges have existed since 1951, and there are a number of other services for which fees are charged. Sometimes the charge is made to cover some of the cost of treatment, for example, dental fees. In other cases it is because the service is not covered by the NHS, for example, medical reports for insurance companies, claim forms for referral for private care and other letters and forms which require the doctor to review the patient's medical records.

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 own costs such as staff, buildings, heating, lighting etc., in the same way as any other small business. The NHS pays the doctor for specific NHS work, but for non-NHS work the fee has to cover the doctor's costs.

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

• Private prescriptions*
• Private sick notes (if requested for the first 7 days when patients can self certificate)
• 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
• Some travel vaccinations
• Private medical insurance reports
• Holiday cancellation claim forms
• Referral for private care forms
• Other letters requested by, or on behalf of, the patient

*A doctor can write a private prescription for a patient if they feel it is clinically appropriate and they are happy to take responsibility for that prescribing decision. Under NHS regulations, a Dr, or his deputy, can write a private prescription for a patient but cannot charge the patient a fee for doing so if the patient is registered for NHS care with that GP/practice. The only exceptions to this rule are when an NHS GP writes a private prescription for:

• Drugs that are being issued solely in anticipation of the onset of an ailment whilst outside the UK, but for which the patient does not require treatment when the medicine is prescribed, or,
• Drugs issued for the prevention of malaria

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/DVLA
• Examinations of local authority employees

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/her registered patients. GPs have a very heavy workload and paperwork takes up an increasing amount of their time.

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. Therefore, in order to complete even the simplest of forms, the doctor needs 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 will I be charged?

The BMA recommends that GPs tell patients in advance if they will be charged, and how much. It is up to the individual practice to decide how much to charge, but the BMA produces lists of suggested fees for the Doctors to use as a guideline.

Charges at Shotfield Medical Practice

At Shotfield Medical Practice we have a guide to private fees available at reception, and they are also listed below.

You will be asked to pay the fee by Debit/Credit card/cash or cheque at the time you request the form/letter. No work will start on the request until the payment has been made. We do not hold cash on the premises so please try and ensure you bring correct money if paying by cash. Otherwise please make all cheques payable to Shotfield Medical Practice.

What can I do to help?

Not all documents need signature by a doctor. For example, you could ask another person in a position of trust, who may be willing to sign a passport application or other similar document free of charge, eg bank manager, teacher, and accountant.

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. We normally say you should allow a minimum of 10 working days for the processing of such forms and always ring to check they are ready before you attend to collect them.

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.

What if I cannot afford to pay a fee?

The practice recognises that many of our patients may have significant financial difficulties and would not wish to increase their financial stress. For this reason the practice offers two levels of support:

1. Provide the patient with a summary of their medical record including key diagnosis and current medications as previously recorded and read coded in their medical record. There is no charge for this level of support.
2. Provide a specific letter or report to patients for a fee.

Whilst we understand the financial pressures patients may be experiencing, we receive a high volume of these requests and set all of our fees based on the time the GP takes to complete the work, so that we are equitable to all patients and our doctors. We are not able to negotiate our rates or offer reduced prices.

• Passport signing is not undertaken by any doctor at the practice
• The Metropolitan police will pay a fee of up to £38.00 for a brief/basic statement/report and there is a form to complete to claim this fee which should be provided by the patient requesting the report. Further charges may apply if a request is made for more detailed information.
• Travel fees are on on a separate website page which can be found here.