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. Sometimes the charge is made to cover some of the cost of treatment, for example, dental fees; in other cases, it is because the service is not covered by the NHS, for example, medical reports for insurance companies.

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.

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.

• accident/sickness insurance certificates
• certain travel vaccinations
• private medical insurance reports

• medical reports for an insurance company
• some reports for the DSS/Benefits Agency
• examinations of local authority employees
• DS 1500 Form (Disability Living/Attendance Allowance)

The BMA suggests fees for non-NHS work which is not covered under a GP’s NHS contract, 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.

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.

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.

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. Surgeries often have lists of fees on the waiting room wall based on these suggested fees.

• Not all documents need signature by a doctor, for example passport applications. You can ask another person in a position of trust to sign such documents free of charge.
• 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. You should expect the form(s) to take up to 4 weeks for the GP to complete and return