Fees for part-time medical services
December 2004
Factors to consider when setting professional fees
For NHS general practitioners, whose expenses for NHS work are reimbursed from the public exchequer, a key consideration in taking on non-NHS work will be to cover the expenses incurred in doing it. The expenses to cover will include elements of the GP’s practice staff, premises and equipment, which will vary between one part of the country and another, as well as medical indemnity and professional subscriptions. If mileage or travelling expenses have been incurred these should be included. GP incomes are practice based from 1 April 2004 and the figures that are provided by the Doctors and Dentists Review Body (DDRB) no longer provide the most verifiable picture of the net incomes of GPs in the future. Under the GP contract implemented on 1 April 2004, practice expenses are now reimbursed for the specific service for which a practice is contracted, rather than being reimbursed across all the practice’s activities. This means that the expenses for any work a practice undertakes which are not funded within the various GP contract funding streams must be funded within the fee that the work attracts. Clearly the actual reimbursement varies from GP to GP, as do the actual expenses of each GP. In carrying out work outside their NHS commitments GPs may wish to consider the extent to which additional costs are incurred.
For other doctors the same calculation will be necessary: the cost of the expenses incurred in providing the particular service, where these are not met in some other way by the NHS, needs to be considered.
Once that calculation has been made, the doctor needs to consider the ‘professional’ element of the charge. This should reflect not only the time devoted to providing the service but also the doctor’s assessment of the value of the professional training, skills and clinical experience he/she brings to the work in question.
Charges may vary from patient to patient, and consideration must be given to such matters as the variable length of consultation, which may be determined by the complexity of the case or difficulties in communication.
In determining what, if any, fee to charge, a doctor should be aware of the extent of the responsibility they are undertaking and should decide what they consider to be a fair and reasonable fee in the light of the time and effort needed.
Where settlement of the fee is the responsibility of the patient or person to be examined, the doctor’s professional fee should be discussed and agreed with the patient before the final agreement to do the work. The BMA publishes a leaflet entitled 'Why do GPs charge fees?' which is available free of charge to BMA members and members of the public from the BMA website. BMA members can also request a copy free of charge from askBMA. This leaflet suggests that doctors might like to consider charging a lower fee per item of service when the patient submits several similar forms at the same time.