Paragraphs 33 – 39 of the Terms and Conditions of Service for NHS Medical and Dental Staff, under which junior doctors are employed, sets out, in broad terms, the work that should be carried out under a standard contract and the work that attracts an additional charge from practitioners.
The Terms and Conditions of Service divides work into two categories with examples of the types of activities that would fit under each.
Category 1 work is “reasonably incidental to a practitioner's duties under his or her contract of employment and its associated job description or job plan.” There are more details in paragraph 36 of the Terms and Conditions of Service.
Category 2 work is defined as “examinations and reports which are not part of, or reasonably incidental to, normal contractual duties.” Practitioners are entitled to charge for work carried out under this category. There are more details in paragraph 37 of the Terms and Conditions of Service.
A practitioner may undertake and retain fees for certain work provided that it would not (in the opinion of the practitioners employing authority) interfere with other NHS activities or with the proper discharge of the practitioner's contractual duties. In addition, a practitioner should not receive a fee or other remuneration for the provision of services which they are required to provide by virtue of their contract of employment.
Examples of Category 2 work
One of the examples of work that junior doctors will encounter most often is certifying cremation forms. Other examples are given in paragraph 37 of the Terms and Conditions of Service but please note that this is not an exhaustive list.
Examples include completing examinations and reports for any of the reasons listed below:
- Medical assessments for benefits (defined as a referral from the DHSS)
- Life insurance
- Prospective emigrants including X-ray examinations and blood tests
- Coroners, as well as attendance at coroners' courts as medical witnesses
- Courts, when attending in a professional capacity, (unless this relates directly to the professional concern of the practitioner or their employer)
- Armed forces recruiters
The charging structure
Paragraphs 33 and 34 of the Terms and Conditions of Service also set out how charging for category 2 work should function in practice. There are two elements to any charge:
- Charge for professional services
- Charge for use of hospital facilities
This charge can be collected by the practitioner or by the hospital. Alternatively, with the agreement of the third party being charged, the practitioner and the hospital can collect their fees separately.
An administration fee can be levied where one party collects a fee on behalf of both practitioner and employer.
In some cases the BMA has agreed a set of fees with industry and government bodies to simplify the process on behalf of doctors.
The level of fees can also be agreed directly between the practitioner and the third party where appropriate and the local employer does not have the authority to set a charge on behalf of practitioners.
What this means in practice
Practices vary across the country, but the TCS does set out a number of general principles:
- Junior doctors are not obliged to complete any work which falls under category 2 above.
- Where they do complete this work, they are entitled to a fee for their professional services.
- The employer is also entitled to levy certain fees:
- Charging the third party (e.g. a local authority) for the use of NHS resources
- Charging the practitioner for administration where it collects a fee on the practitioner’s behalf (and vice versa).
- The employer is entitled, as employer, to prohibit doctors from doing this work if it believes that this would interfere with other contractually agreed work.
- However, the employer is not entitled to withhold fees from practitioners who carry out this work on the basis of their rota, their level of seniority, or any other consideration.
Public health doctors and GPs
Public health doctors are covered by these regulations. However, a number of additional chargeable activities apply to them as detailed in paragraph 37 of the Terms and Conditions of Service.
Those doctors employed on GP contracts are not covered by these regulations.
The Certification of Death (Scotland) Act 2011 includes changes to the way death is certified, which are expected to take effect in 2015. The BMA will update its guidance to reflect these changes.
Terms and Conditions of Service for NHS Medical and Dental Staff (England) 2002
Juniors contract section 7 information on fees