What services NHS GP practices can and cannot charge for
Regulations 24 and 25 of the GMS Regulations provide detailed provisions around the fees that NHS GP practices are entitled to charge. Read more.
What NHS GP practices cannot charge for
NHS GP practices cannot charge fees to registered patients or temporary residents for:
- the provision of any “treatment” which is required to be provided to the patient under the GMS contract;
- the provision of any "treatment" which is required by the patient but is outside the terms of the GMS contract; and
- providing a prescription.
Exceptions
The prohibition on charging fees in these circumstances does not apply if they come within the scope of one of the categories in Regulation 25.
What NHS GP practices can charge for
If the patient is a registered or temporary patient of the NHS practice
An NHS GP practice can charge for services other than treatment or the provision of a prescription.
If the patient is not a registered or temporary patient of the NHS practice
Then an NHS GP practice would not be in breach of Regulation 24(2) by charging a fee for the provision of treatment or prescription (but may be in breach of another part of Regulation 24).
Exceptions
An NHS GP practice cannot charge a fee in the following narrow factual circumstances:
- assessments of registered or temporary patients to assist creditors in deciding what action to take where the debtor has a mental health problem; and
- services to patients who are not registered with the practice for immunisations requested in connection with travel abroad or providing or prescribing malaria drugs.
If a patient seeks essential services from an NHS GP practice but the NHS GP practice has doubts as to whether the patient is registered with the practice, a fee can be charged for providing the services. If it turns out that the patient is registered, the fee is repayable.
The position of individual GPs
Salaried GPs
The restrictions in Regulation 20(6)(a) do not apply to salaried GPs who work in a GMS practice. Such doctors are fully entitled to divide their time between delivering NHS services and delivering private primary care services.
Sole practitioners or partnerships
Where a GP enters into the GMS contract in their own name as a sole practitioner or as a partner, this individual doctor can only provide private primary care medical services outside core hours. This is a highly restrictive provision because a contracting GP is not contractually obliged to devote all of his or her time to the delivery of GMS services during core hours.
Limited companies
If the “contractor” to a GMS contract is a limited company, say company A, the restrictions on providing private medical services apply to the company alone and not to the individual GPs who own shares in the company and/or are directors of the company. It would therefore be open to the same GPs who hold shares in the company and work in the NHS practice to form a separate limited company, company B, to run a private medical practice.
As long as those services are clearly separated from the delivery of NHS services and Company A continued to discharge its duties in full under the GMS contract, it would be possible for Company B to provide its services:
a. To patients of the NHS practice run by Company A;
b. From the practice premises occupied primarily by Company A (subject to apportionment under the The National Health Service (General Medical Services Premises Costs) Directions 2024); and
c. Both during core hours and outside core hours.
Charges for non-NHS services
There are some services that are not available on the NHS – or only in very limited circumstances, for instance cosmetic procedures, some advanced dermatology procedures, osteopathy.
GPs can set up private practices to provide these services although they must not be treating their practices’ registered patients.
Locum GPs without a registered patient list
Locum GPs must be able to charge patients privately for any service they chose to provide. However, where a locum is covering for a practice doctor on leave, they are temporarily contracted to care for a registered list and they cannot charge those patients.
The sale of goodwill
The regulations relating to the sale of goodwill refer to restrictions in relation to a medical practice which has a list of registered patients. This relates to all practices providing essential services, not affecting the potential to provided non-essential services privately. However we continue to advise doctors to follow the advice above and not treat any registered patient privately except where indicated.
GPs can benefit from the sale of goodwill if they have shares in a company or co-operative that does not have a registered list. This will be a commercial decision for a GP or practice to make, in the same way as they may choose to have shares in any other category of company.
Making your practice a limited company
- It may be possible to save tax if you set up your practice as a limited company.
- Specialist accountancy advice would need to be sought before any decision was made.
- A limited company is able to contract to a CCG for the provision of GMS services/PMS services. Doctors in such a practice will need to write to NHS BSA to obtain employer status.
- The salary that the doctors draw from the company is able to be pensioned in the NHS pension scheme on a practitioner basis.
- Any such doctors will need to consider how much they pay themselves as salary because any dividends taken from the company would not be pensionable.
- NHS BSA suggests that prior to establishing the company, the doctors write to the agency to ensure that their status is acceptable. This will partly depend on the aims of the organisation as it must be on the ‘not for profit’ basis similar to out-of-ours providers.