Fees for part-time medical services - 2005
December 2004
Category 1 and 2 items of service (Hospital terms and conditions of service, paras 36 and 37, July 1994) – for doctors under contracts before 1 April 2004
36. Category 1: work undertaken by hospital medical and dental staff which is reasonably incidental to contractual duties and for which charges may not be made.
For convenience, such work has been divided into five sub-sections, which are set out below (Categories 1a-1e), with accompanying illustrative examples:
Category 1a: The examination, diagnosis and provision of related reports on a person referred to the health services from a medical source for a second opinion.
For this purpose, reference "from a medical source" means reference from a medical or dental practitioner (including, for example, a medical board) who, having clinically examined a person, requires a second opinion in connection with the prevention, diagnosis or treatment of illness. It does not include reference for examination included in Category 2 or reference from an administrative medical officer who has not clinically examined the person referred.
Examples of Category 1a: examinations and reports include those on:
i) a person referred by a general practitioner;
ii) members of HM Armed Forces (including members of overseas forces serving on duty in the UK) and their families, referred by medical officers who are treating them;
iii) persons referred in connection with diagnosis or treatment by a medical practitioner in the Community Health Service.
(But examinations of and reports required on employees or prospective employees for the purpose of, for example, superannuation schemes fall within Category 2.)
iv) a person referred by an occupational health physician or employment medical adviser following an accident or incident which may give rise to occupational disease or where an employment medical adviser, following a clinical examination of a person or persons, suspects the possibility of occupational disease and seeks an investigation and a second medical opinion;
v) a person referred by a medical officer of a Medical Boarding Centre (Respiratory Diseases) of the Department of Social Security for the purposes of diagnosis and treatment. (But when the second opinion is required solely in connection with a compensation or social security claim, this falls within Category 2a.)
vi) a person referred by a medical interviewing committee set up by the Department of Social Security to advise disability employment advisers of the Employment Service on the working capacity of disabled persons.
Category 1b: The provision of a medical or dental report either to a patient currently under hospital observation or treatment or, with his or her consent, to an interested third party, when the information required is reasonably incidental to such observation and treatment and can be given readily from knowledge of the case without a separate examination or without an appreciable amount of work in extracting information from case notes. (But if a special examination of the patient is required, or the information requested cannot be given readily from knowledge of the case, or an appreciable amount of work is required to extract medically correct information from case notes, the work falls within Category 2, unless it is specifically included in the practitioner's contractual duties as provided by paragraph 30 above.)
Examples of Category 1b services are:
i) doctors' statements given to the patient for social security purposes;
ii) reports required by the Department of Social Security on a person who is under hospital observation or treatment;
iii) reports required by the Employment Service on the working capacity of disabled patients;
iv) reports required by employers (including government departments and local authorities) on employees who are under observation or treatment, eg reports required in connection with sick leave or premature retirement on health grounds. (But information required primarily to serve the interests of the person or his or her employer in such non-clinical contexts as insurance, superannuation, foreign travel or emigration would fall within Category 2.)
Category 1c: Examinations and reports on persons for the purposes of the prevention of illness, under arrangements approved by the Secretary of State after consultation with the profession. (But examinations and reports required by a person or third party primarily to serve the interests of the person, his or her employer or other third party, in such non-clinical contexts as insurance, superannuation, foreign travel, or emigration, fall within Category 2.)
Examples of Category 1c examinations and reports include those:
i) where it is necessary, as a preventative measure, to investigate the contacts of a patient with a transmissible or epidemic disease, such as typhoid or a sexually transmitted disease;
ii) in respect of transmissible disease on entrants to teacher training colleges, applicants for teaching posts, teachers, and any other persons whose course of training, prospective occupation or occupation brings them into close or prolonged contact with children;
iii) on employees or prospective employees (not otherwise covered by sub-paragraph 1c.ii above) of health authorities or NHS trusts, and of local authority education, social services and environmental health departments who may be at particular risk of acquiring or spreading transmissible diseases by reason of the nature of their employment or prospective employment. This includes voluntary workers and employees of voluntary bodies similarly at risk;
iv) in connection with individual screening measures (eg cervical cytology) for the benefit of particular people who, by reason of age, sex, constitutional or other factors not related to the nature of their employment, are particularly at risk of developing specific diseases. (But routine screening of workers, including screening made necessary by the nature of the working environment, is covered either by sub-paragraph 1c.vi below or Category 2k or 2m.);
v) where the defined duties of the practitioner specifically includes such work, examinations and reports on prospective employees of health authorities, NHS Trusts and local authorities (other than those covered in sub-paragraph 1c.ii and 1c.iii above);
vi) where the defined duties of the practitioner specifically includes such work, examinations and reports in connection with the routine screening of employees of health authorities, NHS trusts and local authorities, to such extent as may be approved by the Secretary of State after consultation with the profession. (But this excludes work under sub-paragraph 1c.iii and 1c.iv above; see also paragraph 32.)
Category 1d: Recommendations under Part II of the Mental Health Act 1983:
i) if given by a doctor on the staff of the hospital where the patient is an in-patient;
ii) if given following examination at an out-patient clinic;
iii) if given as a result of a domiciliary consultation carried out at the request of a general practitioner.
Category 1e: Attendance at court hearings as a witness as to fact by a practitioner giving evidence on his or her own behalf or on behalf of his or her employing authority in connection with a case with which the practitioner is professionally concerned. (But attendance at coroners' courts is normally work falling within Category 2).
Category 2: When work undertaken by hospital medical and dental staff on examinations, reports etc does not fulfil any of the qualifying conditions for Category 1 as set out in paragraph 36 above, it falls within Category 2 and charges may be made.
Examples of Category 2 examinations and/or reports include those:
a) on a patient not under observation or treatment at the hospital at the time the report is requested, or a report which involves a special examination of the patient, or an appreciable amount of work in making extracts from case notes - other than in circumstances referred to in Category 1;
b) on a person referred by a Medical Adviser of the Department of Social Security, or by an Adjudicating Medical Authority or a Medical Appeal Tribunal, in connection with any benefits administered by the Department of Social Security;
c) for the Criminal Injuries Compensation Board, when a special examination is required or an appreciable amount of work is involved in making extracts from case notes;
d) required by a patient or interested third party to serve the interests of the person, his or her employer or other third party, in such non-clinical contexts as insurance, superannuation, foreign travel, emigration, or sport and recreation. (This includes the issue of certificates confirming that inoculations necessary for foreign travel have been carried out, but excludes the inoculations themselves. It also excludes examinations in respect of the diagnosis and treatment of injuries or accidents);
e) required for life insurance purposes;
f) on prospective emigrants including X-ray examinations and blood tests;
g) on persons in connection with legal actions other than reports which can be given under Category 1b and reports associated with cases referred to in Category 1b;
h) for coroners, as well as attendance at coroners' courts as medical witnesses;
i) requested by the courts on the medical condition of an offender or defendant and attendance at court hearings as medical witnesses, otherwise than in the circumstances referred to in Category 1e;
j) on a person referred by a medical examiner of HM Armed Forces Recruiting Organisation;
k) in connection with the routine screening of workers to protect them or the public from specific health risks, whether such screening is a statutory obligation laid on the employer by specific regulation or a voluntary undertaking by the employer in pursuance of the employer's general liability to protect the health of its workforce;
l) on a person referred by a medical referee appointed under the Workmen's Compensation Act 1925 or under a scheme certified under section 31 of that Act;
m) on prospective students of universities or other institutions of further education, provided that they are not covered by category 1c.ii. Such examinations may include chest radiographs;
n) examinations and recommendations under Part II of the Mental Health Act 1983 (except where this falls within Category 1d):
i) if given by a doctor who is not on the staff of the hospital where the patient is examined; or
ii) if the recommendation is given as a result of a special examination carried out at the request of a local authority officer at a place other than a hospital or clinic administered by a hospital authority.
Where fees are payable under i or ii above, they will be paid where the practitioner has carried out a special examination whether or not, as a result, he or she completes a recommendation;
o) services performed by members of hospital medical staffs for government departments as members of medical boards;
p) work undertaken on behalf of the employment medical advisory service in connection with research/survey work, ie the medical examination of employees intended primarily to increase the understanding of the cause, other than to protect the health of people immediately at risk (except where such work falls within Category 1a.iv);
q) completion of Form B (Certificate of Medical Attendant) and Form C (Confirmatory Medical Certificate) of the cremation certificates;
r) examinations and reports including visits to prison required by the Prison Service which do not fall with in Category 1 and which are not covered by separate contractual arrangements between the practitioner and the Prison Service;
s) examination on blind or partially-sighted persons for the completion of form BD8 (except where this falls within Category 1b);
t) in respect of sub paragraph s) above, when payment is due in connection with registration with a local authority this will be made by the health authority under the collaboration arrangements in accordance with the appropriate schedule of fees.