Fees for part-time medical services
December 2004
Hospital doctors
The contractual duties of hospital doctors in the NHS are contained in individual contracts of employment, of which the NHS terms and conditions of service should form part.
The dividing line between work for which hospital doctors can or cannot charge is blurred for those employed on NHS terms and conditions of service before 1 April 2004 and for those employed under the new consultant contract in Wales. The overriding principle for doctors under such contracts is that work related to ‘diagnosis, treatment or prevention of illness’ of NHS patients is part of their contractual duties. Examinations and reports ‘reasonably incidental’ to their duties also form part of their NHS obligations and must therefore be provided without charge. Other examinations and reports, which are not ‘reasonably incidental’ to their NHS duties may be charged for; these are described as Category 2 or fee paying work.
For non-consultant hospital doctors, illustrations of Category 1 and Category 2 work are listed in the terms and conditions of service (read more here).
For consultants who are employed under one of the four new national consultant contracts (for England, Scotland, Northern Ireland and Wales – implemented in 2004) there are clearer boundaries between core contractual services and fee paying services. The conditions are described in the terms and conditions of service for consultants and the relevant sections for England, Scotland and Northern Ireland are given in appendices 4 to 6.
Contraceptive services are not normally included in the regular contractual duties of a hospital doctor, and a fee is payable by the employing authority for this work. Work relating to family planning in hospitals cannot be included in the regular contractual duties of a hospital doctor unless the specific approval of the Joint Negotiating Committee for Hospital Medical Staff is first obtained for every such agreement.
Use of hospital facilities – Where a hospital doctor uses hospital facilities in carrying out Category 2 or fee paying work a proportion of the fee is payable to the employing authority as payment for hospital costs. Trusts have the discretion to set their own charges for use of their facilities for Category 2 or fee paying work but only after discussion with the doctors concerned. This should be not be the case for post mortems undertaken in trust facilities at the request of the coroner; in these cases the coroner will pay the trust directly for the use of the facilities. Members are strongly advised to examine carefully their contract of employment or any proposal to amend an existing contract in relation to Category 2 or fee paying work; more detailed information and advice on contracts can be obtained from askBMA.
Local authorities and health authorities (now primary care trusts (PCTs)) in England have a joint duty to provide certain services in the fields of education, social services and public health ('the collaborative arrangements') under the NHS Act 1977 (as amended - see note below). For further information, see Fees guidance schedule 2: Work for local authorities (which can be found here).
Note: S26 as amended by the Health Services Act 1980. Health boards in Scotland may fund services under the collaboration arrangements under the NHS (Scotland) Act 1978 (S13 amended by HSA 1980) and, by agreement with the Scottish Office Department of Health, have done so since 1982.