A realistic assessment of time is required to perform professional obligations. In practice this means allowing reasonable time for clinical work such as consultations and completing reports as well as administrative work e.g. referral letters, requests for medical tests.
Knowledge and experience
Postgraduate qualifications, length of service as a medical practitioner, organisational responsibilities, practice area and familiarity with local healthcare systems (including the third party organisation requesting the service).
Income the medical practitioner might forego in providing the service e.g. the cost of a consultant’s time measured as the number of consultations or the value of the work, which would otherwise not be undertaken during that time.
Administrative and accounting systems, accountancy and legal advice, applicable office rental and utilities, office equipment (e.g. furniture, telecommunications and information technology), medical equipment, stationery expenses, administrative support and office cleaning.
Medical practitioners bear professional costs of practice including time and expense of continuing professional development, medical indemnity, applicable appraisal costs and subscriptions for General Medical Council (GMC), the BMA and Local Medical Committees (LMCs), specialist societies, Royal College and other professional organisations.
(where applicable) - Fuel costs, vehicle wear and tear, attendance at surgery and visiting patients outside the usual geographical area of work.
Working in unfamiliar environments, availability of colleagues and other medical staff for advice and support, high workload patients (e.g. patients in nursing homes), familiarity with equipment (e.g. computer systems), work type and intensity of session (e.g. open access, booked appointments).
Medical practitioners undertaking self-employed work will not be paid for leave relating to sickness, family reasons, holiday or study, or for any unfilled sessions.
Prior to charging for, or refusing certain work, consider any ethical implications as patient care is important. There is however no obligation to be an expert where there is no ongoing duty of care.
Other factors to consider
Agreeing fees with individuals and organisations
Where settlement of the fee is the responsibility of the patient or individual (as distinct from an organisation) the medical practitioner's professional fee should be discussed and agreed with the patient or individual before undertaking the work.
Our guidance Why GP's sometimes charge fees - could come in handy when having those discussions. It answers the questions that people may have about this area of fee-paid work.
Medical practitioners must also make sure they comply with their professional responsibilities as outlined in the GMC publication Good Medical Practice (2006) but in particular paragraph 72 under 'Probity - Financial and commercial dealings'.
Agree fees and terms and conditions (T&Cs) in writing, before undertaking any work
The T&Cs could address such items as services to be provided by the medical practitioner, time required to perform the work, terms of payment, cancellation and late payment. When drafting these seek your own independent legal advice.
BMA members can speak to one of our advisers
Before entering into a contract with an organisation, medical practitioners should ensure they review any proposed terms thoroughly and make notes of any discussions entered into. It's always best to seek independent legal advice.
Conduct due diligence checks on any commercial organisation you wish to deal with
A report from a credit-rating agency may disclose any county court judgments, risk warnings and the financial position of the organisation.
Following discussions with the Office of Fair Trading (OFT) in 2000, the BMA was required by competition law to discontinue publishing suggested fees for services which could be provided by any medical practitioner.
Read our guidance on services where there is no existing fee agreement in place. It provides a full list including locum fees and medico-legal fees.
The OFT directed that the BMA was not permitted to suggest nor publish fees unless they fell within the following categories:
- If the fees were agreed between the BMA and third party organisations for specific items of work (not including any extensions to that work)
- If the fees were published by Government organisations (who have exemption from the Competition Act)
- If the fees were for services only able to be provided by a patient’s own GP or other attending doctor.
In cases where we are unable to suggest fees for services which can provided by any medical practitioner, doctors are advised to set their own fees.
Fees and your pension
Under the current GMS contract for GPs, fee-based payments for NHS work (net of expenses) are pensionable. That means fees paid directly to a GP provider or practice by an employing authority, are pensionable.
GPs should pension these either as an individual through form SOLO or, if pooling the income into the practice, through the annual certificate of pensionable profit.
This arrangement applies to England, Wales and Northern Ireland and should be considered when doctors are setting their own fees.
GPs working in Scotland, however, should check with the Scottish Public Pensions Agency about the procedures for pensioning such income.
Where hospital doctors carry out work under collaborative arrangements, fees are only pensionable if paid on a sessional basis.
Please remember that in order to achieve a comparable pension to that provided by the NHS Pension Scheme, the value of pension contributions would need to be carefully considered.
BMA members don't forget you can get specially tailored help from our Pensions Department.
However, for individual financial advice relating to pensions, medical practitioners should consult an independent financial advisor (IFA).
These and other financial services and general products are available to BMA members on the BMA Services website or telephone 0845 609 2008.
Find out more about GP contracts
Check the pensions section
Types of fee agreements
It is important to establish whether the fees for the work being requested are subject to:
- National agreement
- Local agreement with the relevant local authority and or health provider
- Or whether the doctor has to set and agree their own fees for this work.
The BMA’s Professional Fees and Forensic Medicine Committees negotiate some national fee agreements for:
- Central government work
- Medico-legal work
- Insurance work
- A wide range of reports, examinations and certificates for individuals/patients or third party organisations
- Cremation certificates
- Coroners' work
- Forensic physicians
While we and other third party organisations encourage the use of these fees, it is ultimately the decision of the individual medical practitioner as to whether to adopt them for the work undertaken.
You should be aware too, that it is becoming increasingly difficult for us to maintain national agreements with third party organisations across the full range of non-NHS activities. Such agreements with new bodies may not be possible
If you are a BMA member, find out more by speaking to one of our advisers.
Local and individual agreements
Where there are no nationally agreed fees in place, medical practitioners remain free to charge their own fee although they must be extremely vigilant about the impact of competition laws.
In particular, caution should be exercised not to engage in prohibited activities which invariably attract Office of Fair Trading investigations e.g. colluding with other medical practitioners in relation to setting fees.
VAT medical indemnity and debt recovery
How do you decide whether or not VAT is applicable?
Where the principal purpose of the medical service is the protection, maintenance or restoration of the health of an individual then the services will be exempt from VAT.
Primary heath care provided through either the NHS or the private sector will be exempt from VAT.
However, if the purpose of a medical examination or report is to enable a third party organisation (e.g. insurance companies) to decide a course of action the medical services are subject to VAT (at the standard rate).
Medical practitioners whose income (subject to VAT) exceeds the VAT threshold (currently £67,000) must register with HM Revenue & Customs.
Medical practitioners who are already VAT registered (e.g. as a result of dispensing changes which took effect on 1 April 2006) must ensure that they account for VAT on any affected services from 1 May 2007.
For further information on VAT please refer to the HMRC’s VAT website, in particular HMRC Reference:Notice 701/57 (January 2007)
Medical practitioners must ensure that they have medical indemnity for professional fee (non-NHS) work as such work is not covered by NHS indemnity. For further advice please see our guidance on NHS indemnity.
Medical practitioners who have undertaken professional fees work may experience delays in payment or may be unable to recover payment for such work.
Where reasonable attempts to recover outstanding monies prove unsuccessful, medical practitioners may wish to consider legal action after getting independent legal advice.
Settlement of such disputes could entail the following:
Writing a letter before action to the owing party, setting out the medical practitioner’s demand for the outstanding payment and the medical practitioner’s intention to commence court proceedings if prompt payment of the outstanding monies is not forthcoming.
Lodging a small claim in a court of competent jurisdiction for which further guidance is available from
Her Majesty’s Courts Service.
In the case of medico-legal work, lodging a complaint against the instructing solicitor firm for outstanding or late payments. All solicitors’ firms must have a written complaints procedure - for further information contact the relevant Law Society.
Browse our fee finder pages