Charges for additional services
Private practice is still significantly restricted under the GMS contract. Practices that opt out of the provision of additional, enhanced or out-of-hour services, cannot charge any of their registered patients for supplying a similar service privately.
For instance, GPs cannot charge a patient in their practice for seeing them out-of-hours even though the patient may have requested it and may be happy to pay for it. If the patient is a registered patient they cannot be charged.
However, GP practices are private businesses and can enter into commercial contracts with other businesses and provide services privately, but only to an extent that is not prohibited by the GMS contract.
An example is a contract under which a GP agrees to visit a care home to treat patients, instead of requiring the patients to attend the practice.
An agreement where the GP will always go to the patient (for example a certain number of visits to a care home per week) instead of the care home to transport the patient to the practice, is arguably an agreement for a service which is over and above the services contracted under the GP’s NHS contract. Practices are advised to check with their CCG before entering into such a contract.
Doctors may wish to write private prescriptions for patients, however cannot charge for the service.
Doctors cannot sell blood pressure machines to patients.
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.
- Hepatitis A vaccination is available free of charge on the NHS if the patient is going abroad.
- Hepatitis B vaccination is not free of charge if the patient is going abroad.
- Hepatitis B vaccination is free for occupational reasons because patients are dental nurses or about to enter medical school. However, a GP does not need to provide them under essential services.
- Therefore patients can either seek vaccination privately (eg through a travel clinic) or, as would be most suitable for those about to embark on training/work within the NHS, through an occupational health local enhanced service.
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.