Why GPs sometimes charge fees
Surely the doctor is being paid anyway?
It is important to understand that many 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 fees charged by GPs contribute towards their costs.
What is covered by the NHS and what is not?
The Government’s contract with GPs covers medical services to NHS patients, including the provision of on-going medical treatment.
In recent years, however, 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 ensure that information provided to them is true and accurate.
Examples of non-NHS services for which GPs can charge their own NHS patients:
- accident or sickness certificates for insurance purposes
- school fee and holiday insurance certificates
- reports for health clubs to certify that patients are fit to exercise
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 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 (the doctors’ regulatory body) or even the Police.
Non NHS services fees
Summary
If you provide full details of your non-NHS work request, we will advise if we can assist you and provide either a fixed -fee quote or hourly estimate for GP to complete your report. An additional administration fee of £55 is applied for each piece of work.
You are free to use any other private provider if you wish, you are not obliged to use Leckhampton surgery.
Charges are higher than previous years, but the surgery makes minimal income from this work. We do it to assist you with the administrative requirements of life, that the NHS does not cover.
Once work is agreed, payment is taken in advance.
Any DVLA requests are usually funded with a standard fee paid to the surgery by DVLA. Should the work that is required to undertake the assessment/complete the report exceed this amount, we will need to obtain written approval in advance from the DVLA before we are able to proceed. This may unfortunately result in the surgery declining your request or a delay in your request being completed.
We want you to be happy with the work we do and will try to resolve disagreements around wording. However, you are paying for the work required to complete the document, not just the document itself, so fees remain payable in the event of disagreement.
Please contact us on 01242 539080 or email leckhampton.secretary@nhs.net with your requests.
Background
GP surgeries have always undertaken private work for patients, to help them with matters arising in daily life that are not covered by the NHS (insurance policy administration, travel claims, occupational assessments, driving and sporting/recreational matters etc). The type of private work we can do is governed by our NHS contract. Providing this service has become more challenging due to the increase in NHS work, which we prioritise to ensure our patient’s medical care is not adversely affected by non-clinical private work, and staff shortages. The surgery is under no obligation to provide non-NHS work but we recognise that providing it is useful for our patients and we would like to be able to assist you.
The charges for non-NHS work were always modest but have increased over recent years, to cover increasing costs in the business. Non-NHS work remains a small part of our business and assessment by the British Medical Association has identified that it is not usually a profitable activity, due to the administrative and clinical overhead costs.
The surgery stopped doing private work for a period if time in 2022 due to staffing shortages and we would expect this to happen intermittently over the coming years, due to ongoing problems with medical recruitment, which is outside of our control. We recognise the inconvenience this has caused our patients and we are sorry for this.
The way forward
The surgery would like to assist patients with their non-NHS needs, as we recognise that we are often the most convenient provider for this activity. We have a new fee structure and process to enable us to accurately quote for your work. Sometimes we can offer a flat fee option, but we will often quote an hourly rate with estimated/minimum time required as, in the past, we have found some work to take many times the expected duration. We will not agree to work if we have not seen the full requirements in writing.
We will not undertake all non-NHS work and the work we do undertake will alter month to month, depending on NHS demands and staff availability. Once you have provided our admin team full details, including all the forms and/or letters, that relate to your request we will provide you a firm or approximate costing and likely timescale.
You are free to arrange non-NHS work with any other provider, they may be cheaper and faster, or they may be more expensive, and delays may occur as they do not hold your medical records on file. All patients now have the right to access to their complete medical records online but you will need to sign up to our online services which you can do through this website or the NHS app, if you have not already got an account. You will need to include copies of your ID to get full medical record access. You can then print off anything required’
Fee structure
Fees are dependent on your exact needs – we need to see all paperwork to give an accurate costing. Any work subsequently arising (other than due to our factual errors) is additionally charged.
The administration fee for each piece of work is £55
Our hourly charge for the GP to complete your report is £300. Payment is required in advance. Where a fixed fee is not offered, we take payment for the estimated amount in advance, with refund or further charges on completion. If you ask us to halt work after instructing us you will be charged for any work already completed based on our hourly rate + the admin fee.
The time required to complete your work varies according to the clinical and medico-legal risk associated with the matter at hand, as well as the complexity of the patient’s medical history. For example: the time required to complete a sporting event participation form for a fit and well 20-year-old is not the same as the time required to complete the form for a 70 year old with multiple cardiac conditions (we may decline to certify high risk patient for activities of this nature).
Examples for basic guidance only: simple signature 10 minutes, assessment of notes and background details for signature 20 minutes, DVLA form (simple) 20 minutes, DVLA form (detailed) 40 minutes, DVLA form (complex or multiple) 60 minutes +, firearms 20-40 minutes depending on which form is provided, insurance reports 30-120 minutes.
DVLA specific advice
The surgery is not obliged to complete work for the DVLA, but we are the logical organisation to do this. The DVLA often does not fund this work adequately as they seem to make no logical distinction regarding the complexity of the work and their fees do reflect our business costs. Often this work needs a clarification phone call with the GP and extensive notes review – sometimes taking more than an hour of GP time, plus administration team and reception actions.
The DVLA will usually pay £40-85 towards your form. This payment does not always cover the cost of the Clinician undertaking this work. If you wish us to complete DVLA work and the cost of this exceeds their normal fee, we will need to obtain written approval in advance from the DVLA before we are able to proceed. This may unfortunately result in a delay with your request being completed or the surgery declining your request if funding is not approved.
You may choose an alternative provider. Unfortunately, many alternate private providers will also decline to do this work as it is underfunded by the DVLA and the contractual issues surrounding the fee structure and patient charging are opaque to say the least. Private providers will often decline DVLA work and tell you that “your surgery has to do this for you” – After a detailed assessment of our contract with the Government this is not correct, but we understand their confusion.
Disagreements about the contents of non-NHS letters and forms
Please remember that if we have been commissioned by a third party (DVLA, insurer etc) to provide a report then we have both a duty to you and a duty to them, even if it is the patient who is paying for the report. These duties usually co-exist happily but, on occasion, they can be a source of friction when it comes to wording of reports.
Occasionally patients are unhappy with what the doctor has put on their letter or form. Usually this is a misunderstanding and can be easily rectified. As long as you have provided us with all the information necessary at the outset then there is no extra charge for correcting a simple misunderstanding, it’s easy to confuse a date of holiday booking with a date of holiday cancellation and we do understand this.
Sometimes there may be a clear factual error made by the doctor, we will correct this as soon as possible without charge with our apologies.
Occasionally patients may feel there is an error, but the GP feels that their opinion is medically correct, and this is a difference between the ‘patient perspective’ and the ‘medical perspective’. For example, you may feel that your holiday was cancelled due to ‘food poisoning’ but the doctor may feel that statistically it is more likely that your holiday was cancelled due to ‘viral gastroenteritis’ – in this example the doctor would offer to explain why we have completed the form with the wording used, but would not change the wording to reflect your opinion if we felt it medically inaccurate. As the work had already been completed then it would still be chargeable, even if you were not in agreement with the statement. If there are unresolvable differences of opinion then we may decline to provide future non-NHS work for you, as it may not be cost effective for us to do so.
Non-payment of fees
Payments are usually taken in advance. However, on occasion, part/all of your fees may be due on completion, prior to collection of letters/forms. Unfortunately, we have previously had patients refuse to pay for work completed. If this is due to a disagreement, then we will try to resolve this as above. If payment is not made, then we will not complete any future non-NHS work on behalf of your household as it is not cost effective for us to do so.
How to contact us
Thank you for taking the time to read this summary of non-NHS work. If you would like to commission us to provide non-NHS work please get in touch by telephoning 01242 539080 or email leckhampton.secretary@nhs.net. Please provide as much information as possible so we can give an accurate costing and timescale. If work arrives directly to the surgery (insurance, DVLA, etc.) then we will be in touch with you with a quote.
