The National Health Service provides most health care to most people free of charge, but there are exceptions such as prescription charges.

The NHS does not employ GPs, it has a contract with them to provide NHS general medical services for their patients. Sometimes, however, GPs are asked to provide additional services, which fall outside their contract with the NHS, and in these circumstances, they are entitled to make a reasonable charge for providing them.

Isn't the NHS supposed to be free?

The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951, and there are a number of other services for which fees are charged. For example medical reports for insurance companies

Surely the doctor is being paid anyway?

It is important to understand that GPs are not employed by the NHS, they are self employed and they have to cover their costs - staff, buildings, heating, lighting, etc – in the same way as any small business. The NHS covers these costs for NHS work, but for non-NHS work the fee has to cover the doctor's costs.

What is covered by the NHS and what is not?

The Government's contract with GPs covers medical services to NHS patients. In recent years, more and more organisations have been involving doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to be sure that information provided is true and accurate.

Examples of non-NHS services for which GPs can charge their NHS patients are:

• Accident/sickness insurance certificates
• Certain travel vaccinations
• Private medical insurance reports
• Statements of fact relating to general health e.g. for children’s dance classes,
• Letters requested by, or on behalf of, the patient
• Holiday cancellation claim forms
• Referral for private care forms 

Examples of non-NHS services for which GPs can charge other institutions are:

• Medical reports for an insurance company
• Some reports for the DSS/Benefits Agency
• Examinations of occupational health
• Requests from solicitors for patient records

Is it true that the BMA sets fees for non-NHS work?

The BMA suggests fees for non-NHS work which is not covered under a GP’s NHScontract, to help GPs set their own professional fees. However, these fees are guidelines only, not recommendations, and a doctor is not obliged to charge the rates suggested.

Why does it sometimes take my GP a long time to complete my form?

Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload - the majority work up to 70 hours a week - and paperwork takes up an increasing amount of their time, so many GPs find they have to take some paperwork home at night and weekends. 

I only need the doctor's signature - what is the problem?

When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient's entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council or even the Police.

What will I be charged?

The BMA recommends that GPs tell patients in advance if they will be charged, and how much. It is up to the individual doctor to decide how much to charge, but the BMA produces lists of suggested fees which many doctors use.

What can I do to help?

If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them all at once as a 'job lot' at a reduced price. 

Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this will cost more.