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Charging your NHS patients

Offering extra services to your patients for a fee breaches your NHS contract. By Justin Cumberlege.

As the NHS increasingly defines the medical healthcare it is prepared to pay for, GPs may feel that they should decide which non-NHS services they can offer their patients on a fee-paying basis. This may be the view of GPs I have heard about who offer private services such as Botox and laser treatments to their NHS patients.

Breach of contract
However, such GPs are in breach of their NHS contract. Regulation 24 of the National Health Service (General Medical Services Contracts) Regulations 2004 requires that GPs must provide treatment free of charge to any patient on their practice's list. This is regardless of what service is provided.

To sidestep the regulations, some GPs arrange with a neighbouring practice to cross-refer NHS patients for private treatment. Other practices charge people who are not on their patient list, and are then faced with the choice of denying the treatment to their NHS patients or providing it free of charge.

Teaming up with another practice might seem to be a solution. But Regulation 24 says that: 'The contractor shall not, either itself or through any other person, demand or accept from any patient of its own a fee or other remuneration, for its own or another's benefit ...' So you need to ensure that you, as the contractor, are not asking for payment, and that no one else is asking for payment on your behalf.

Altruistic arrangement
As neither you nor anyone else must receive the benefit of any payment, that means any arrangement needs to be entirely altruistic, and as such is not much of an incentive to invest time, energy and money, into providing an extra service that some of your patients will be happy to pay for.

Alternative forms of contract do not help because PMS and APMS contractors are subject to the same restrictions on charging patients who are registered with them.

However, GPs can charge for services specifically set out in Schedule 5 of the regulations. These include routine medical examinations for employers or schools; providing immunisations the NHS does not pay for those travelling abroad; medical examinations relating to road traffic accidents and others.

Being able to increase patient satisfaction and practice profits by adding services - whether 'lifestyle' treatments or others that the NHS will not pay for - will help to retain the holistic patient relationship and give GPs an edge over increasing competition, so surely it is time to lift the Regulation 24 ban.

GPs ignoring it run the risk, at least in theory, of their GMS contract being terminated.

  • Justin Cumberlege is a solicitor specialising in primary healthcare law at Carter Lemon Camerons LLP.

GMS Contract

  • Regulation 24 requires GPs to provide treatment free of charge to any patient registered on their practice's list.
  • Schedule 5 of the regulations specifies the services that GPs can charge their patients for (insurance medicals, for example).

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