The National Health Service provides most health care to most people free of charge, but there are a number of other services for which fees are charged. Sometimes this 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 have to cover their costs, staff, buildings, heating, lighting, etc. in the same way as any small business. The NHS covers the cost of NHS work but for non-NHS work the GP 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 work that goes beyond medical care. Sometimes the only reason that a GP is asked is because they are in a position of trust in the community, or because they are able to give a medical opinion. GPs do not have to carry out non-NHS work, but they often do to help patients or support services.

The following are examples of work not covered by the NHS:

• Accident/sickness insurance certificates
• Certain travel vaccinations
• Private medical insurance reports

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 are guidelines only, not recommendations, and a doctor is not obliged to charge the fees suggested.

Time spent completing forms and preparing reports takes the GP away from the medical care of their patients. Most GPs have a very heavy workload, and the majority of their time is spent on NHS patient care. Forms and reports are not part of the NHS contract, so many GPs may have to take time away from their normal work to complete paperwork.

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 form, the doctor may have to check the patient’s entire medical record. Occasionally a doctor may be asked to sign a certificate or complete a report when the General Medical Council or even the police will later question it.

The BMA recommends that GP fee lists are displayed in advance. The fees will be charged, and how much, is up to the individual doctor or practice. The BMA produces a list of suggested fees which many doctors use. Suggested fees have been set in line with waiting room prices and are based on these suggested fees.

• Not all documents need a doctor’s signature. For example, a passport application. You can ask another person in a position of trust to sign the document.
• If you have several forms requiring completion, present them all at once and ask your GP if they are prepared to complete them all at once as a lot of time is required.
• Do not expect your GP to process forms overnight. Urgent requests may mean the doctor has to make special arrangements to process the form quickly, and this will cost more.