A realistic assessment of how much 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 and requests for medical tests).
Knowledge and experience
- Postgraduate qualifications.
- Length of service as a doctor.
- Organisational responsibilities.
- Practice area and familiarity with local healthcare systems (including third party organisations).
Income that you might forego in providing the service.
In practice this could be 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 and cleaning.
- Medical equipment.
- Stationery expenses.
- Administrative support.
- Continuing professional development.
- Medical indemnity.
- Applicable appraisal costs.
- GMC, BMA and LMC subscriptions.
- Specialist societies, royal college and other professional organisation subscriptions.
- 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 (eg patients in nursing homes).
- Familiarity with equipment (eg computer systems).
- Work type and intensity of session (eg open access, booked appointments).
Doctors 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 to patient care. There is however no obligation to be an expert where there is no ongoing duty of care.
Agreeing fees with individuals
Where settlement of the fee is the responsibility of the patient or individual your professional fee should be discussed and agreed with them before undertaking the work.
Our guidance Why GPs sometimes charge fees - could come in handy when having those discussions.
Doctors must also make sure they comply with their professional responsibilities as outlined in Good medical practice.
Agreeing fees with organisations
1. Agree fees and terms and conditions in writing, before undertaking any work
- The terms could include services to be provided by the doctor, time required, terms of payment, cancellation and late payment. When drafting these seek your own independent legal advice.
2. BMA members can speak to one of our advisers
- Before entering into a contract, doctors 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.
3. 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.
Fees and your pension
England, Wales and Northern Ireland
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.
GPs 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.
Types of fee agreements
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 encourage the use of these fees, it is ultimately the decision of the individual doctor whether to adopt them.
Local and individual agreements
Where there are no nationally agreed fees in place, doctors 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 can attract Office of Fair Trading investigations e.g. colluding with other doctors 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 health care provided through either the NHS or the private sector will be exempt from VAT.
However, if the medical service is to enable a third party organisation (e.g. insurance companies) to decide a course of action the medical services are subject to VAT.
Doctors whose income (subject to VAT) exceeds the VAT threshold (currently £67,000) must register with HMRC and ensure they account for VAT on any services undertaken.
Doctors 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.
Doctors who have undertaken professional fee work may experience delays in payment or be unable to recover payment.
Where reasonable attempts to recover outstanding monies prove unsuccessful, doctors may wish to consider legal action after getting independent legal advice.
Settlement of such disputes could entail the following:
- Writing a letter to the owing party.
- Setting out your demand for the outstanding payment and your intention to commence court proceedings if the payment is not paid promptly.
- Lodging a small claim in a court of competent jurisdiction. Further guidance: Ministry of Justice.
Lodging a complaint against the instructing solicitor firm for outstanding or late payments, in the case of medico-legal work.