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Your charges for non-NHS work

The fees GPs set for private services are reasonable, our survey shows, but confusion remains.

Over 250 practices took part in our exclusive Medeconomics survey in November and December 2008 to uncover the fee levels charged for non-NHS services for which there are no set or suggested fees. When reviewing their charges for 2009, GPs should find the information gathered on these negotiable fees a useful yardstick.

Photograph: Getty Images

Driver medicals are a potential source of income for many practices

Fees surveyed
The fees we surveyed are for private and professional services commonly provided by GPs at the surgery. As the table shows, fees generally seemed to be pitched at a reasonable level, taking into account factors such as time and complexity of service.

But the survey did produce some surprises. A practice in England charged £300 for a DNA paternity test compared to the average fee of £45. Another practice in England charged either £50 or £60 for all the services in the table, apparently ignoring the relative amounts of work involved.

While the ranges of fees were wide, most practices' charges tended to be clustered reasonably close to the average fee level. The highest fee overall was £500 charged by a practice in England for solicitors' reports.

Deciding the amount
The results do suggest that some GPs and practice managers are rather at sea over how much to charge. One GP in Bedfordshire said: 'I am delighted that you are doing this as I have no idea what to charge for services.'

When setting fees, complexity of service was the most important factor, cited by 87 per cent of respondents.

Ability to pay was taken into account by 80 per cent. A practice manager respondent in England said: 'In some cases GPs decide to waive or reduce fees.'

The fees for other services where there actually are suggested or agreed rates (such as reports on life insurance proposers) were taken into account by 81 per cent when deciding how much to charge.

Specialist medical accountants Ramsay Brown & Partners suggest that a reasonable target for non-NHS income for their GP practice clients (mainly in London and the South East) is total annual income of £7 per patient. Of this an estimated £3.50 per patient is from work performed at the surgery, including the services we surveyed.

Partner Laurence Slavin says: 'These days, with no pay rises, it is important that GPs look at all their potential income sources. But it is common to find the attitude "our patients can't afford these costs" or "reception deals with this", which is another way of explaining that GPs commonly have a difficulty bringing costs into the consultation.

'I am sure many GPs do not maximise this income.'

In Glasgow, David Maclay from Bannerman Johnstone Maclay, another accountancy firm specialising in GPs, says that, historically, some practices lost out on non-NHS income due to poor admin processes.

'It has, however, become clear that practices are now taking this source of income very seriously by reviewing their charges and putting procedures in place for ensuring invoices are issued and remittances are received.'

Reluctance to charge
Paul Kendall from medical specialist accountants Dodd & Co in the North West says: 'There are still a number of doctors who are reluctant or embarrassed to charge fees, for example for signing passport photos.'

However, he reports that some practices actively pursuing more non-NHS income are particularly looking at cosmetic procedures (such as Botox injections). But probably partly due to geographic location, average annual income per patient from non-NHS work earned by both Dodd & Co's and Bannerman Johnstone Maclay's client practices is substantially below what Mr Slavin's clients achieve.

One respondent, a GP in Wales, said: 'I think we often undervalue ourselves. We should take the lead from our legal and dental colleagues.'

This practice charged £240 for a private consultation, a much higher amount than the GP quoted for the other services in the table.

In contrast, a GP in England said: 'Our prices reflect our population, which includes significant social deprivation.' This practice's fees include £10 for a character reference and £65 for a PCV/LGV driver medical.

Confusion over fees
A Northern Ireland GP said: 'There is confusion as to how much we can charge and a reluctance of patients to pay.'

This practice charged modest amounts including £5 for a passport photo countersignature and £20 for a fitness to attend medical and report.

Forty-four per cent of respondents believed that there was scope to significantly increase private and professional fee turnover. For 35 per cent, doing this was high priority and for a further 48 per cent, fairly important. Employment medicals, travel vaccinations, driver medicals and solicitor's reports were seen to have the most potential.

Of the 253 respondents, 70 per cent were GPs and 25 per cent were practice managers. Eighty-six per cent were from practices in England; 4 per cent from Wales, and 5 per cent from Scotland and Northern Ireland.

From respondents' comments, many would like recommended or suggested fees for non-NHS work. However, the Office of Fair Trading has ruled this uncompetitive except for services that can be provided only by the patient's doctor.

What practices charge
ServiceBasic fee rangeAverage feeResponses
Diagnostic blood test£8-60*£21133
Paternity blood test£10-140**£36113
DNA paternity test£10-200***£4109
Character reference (e.g. job, shotgun licence£10-120 £30153
Private cervical smear£10-100£3272
Private consultation£15-240£53173
Elderly driver fitness medical£10-165£63161
PCV/LGV driver medical£20-170£85222
Photocard driving licence signature £3-80 £19174
Electrocardiogram£10-100£3789
Fitness to attend, medical and report
(e.g. sports, school, university)
£5-170£42187
Fitness to attend, report only£5-65£24170
HIV test requested by insurer£5-137£34114
Mental capacity certificate,
with medical
£10-190£79102
Passport photo signature£5-50£19178
Private prescription£2-50£11172
Solicitor's report (not publicly funded)£10-500£77179
Fitness to travel£8-120£22200
Cancellation certificate
(holiday insurance)
£8-75£23223
Source: Medeconomics survey, November/December 2008. Total 252 respondents. Fees are rounded to nearest pounds.
*Highest £160.
**Highest £200.
***Highest £300.

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