Charges for additional services
Private practice is still significantly restricted under the GMS contract. Practices that opt out of the provision of additional, enhanced or out-of-hour services, cannot charge any of their registered patients for supplying a similar service privately.
For instance, GPs cannot charge a patient in their practice for seeing them out-of-hours even though the patient may have requested it and may be happy to pay for it. If the patient is a registered patient they cannot be charged.
However, GP practices are private businesses and can enter into commercial contracts with other businesses and provide services privately, but only to an extent that is not prohibited by the GMS contract.
An example is a contract under which a GP agrees to visit a care home to treat patients, instead of requiring the patients to attend the practice.
An agreement where the GP will always go to the patient (for example a certain number of visits to a care home per week) instead of the care home to transport the patient to the practice, is arguably an agreement for a service which is over and above the services contracted under the GP’s NHS contract. Practices are advised to check with their CCG before entering into such a contract.
Doctors may wish to write private prescriptions for patients, however cannot charge for the service.
Doctors cannot sell blood pressure machines to patients.
Charges for non-NHS services
There are some services that are not available on the NHS – or only in very limited circ*mstances, for instance cosmetic procedures, some advanced dermatology procedures, osteopathy.
GPs can set up private practices to provide these services although they must not be treating their practices’ registered patients.
Locum GPs without a registered patient list
Locum GPs must be able to charge patients privately for any service they chose to provide. However, where a locum is covering for a practice doctor on leave, they are temporarily contracted to care for a registered list and they cannot charge those patients.
Hepatitis vaccinations
- Hepatitis A vaccination is available free of charge on the NHS if the patient is going abroad.
- Hepatitis B vaccination is not free of charge if the patient is going abroad.
- Hepatitis B vaccination is free for occupational reasons because patients are dental nurses or about to enter medical school. However, a GP does not need to provide them under essential services.
- Therefore patients can either seek vaccination privately (eg through a travel clinic) or, as would be most suitable for those about to embark on training/work within the NHS, through an occupational health local enhanced service.
The sale of goodwill
The regulations relating to the sale of goodwill refer to restrictions in relation to a medical practice which has a list of registered patients. This relates to all practices providing essential services, not affecting the potential to provided non-essential services privately. However we continue to advise doctors to follow the advice above and not treat any registered patient privately except where indicated.
GPs can benefit from the sale of goodwill if they have shares in a company or co-operative that does not have a registered list. This will be a commercial decision for a GP or practice to make, in the same way as they may choose to have shares in any other category of company.
Making your practice a limited company
- It may be possible to save tax if you set up your practice as a limited company.
- Specialist accountancy advice would need to be sought before any decision was made.
- A limited company is able to contract to a CCG for the provision of GMS services/PMS services. Doctors in such a practice will need to write to NHS BSA to obtain employer status.
- The salary that the doctors draw from the company is able to be pensioned in the NHS pension scheme on a practitioner basis.
- Any such doctors will need to consider how much they pay themselves as salary because any dividends taken from the company would not be pensionable.
- NHS BSA suggests that prior to establishing the company, the doctors write to the agency to ensure that their status is acceptable. This will partly depend on the aims of the organisation as it must be on the ‘not for profit’ basis similar to out-of-ours providers.
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Regulation 24 of the GMS contract 2004:
- This regulation restricts private practice for General Medical Services (GMS) contract holders, limiting their ability to charge registered patients for services that are similar to those provided privately.
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Charges for Additional Services:
- GP practices that opt out of offering additional, enhanced, or out-of-hour services cannot charge their registered patients for similar services privately.
- GP practices can enter into commercial contracts with other businesses to provide services privately, but there are limitations imposed by the GMS contract.
- For example, GPs can agree to visit care homes to treat patients as part of a commercial contract, rather than requiring patients to attend the practice. However, this should be checked with the Clinical Commissioning Group (CCG) before entering such contracts.
- GPs cannot charge for writing private prescriptions or sell medical equipment like blood pressure machines to patients.
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Charges for Non-NHS Services:
- Some services, such as cosmetic procedures, advanced dermatology procedures, and osteopathy, may not be available on the NHS or have limited availability. GPs can set up private practices to offer these services but should not treat their registered patients in this capacity.
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Locum GPs without a Registered Patient List:
- Locum GPs can charge patients privately for services they provide, except when they are temporarily covering for a practice doctor on leave and caring for registered patients.
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Hepatitis Vaccinations:
- Hepatitis A vaccination is free on the NHS for patients going abroad.
- Hepatitis B vaccination is not free for travel purposes.
- Hepatitis B vaccination is free for occupational reasons, such as for dental nurses or those entering medical school. However, GPs are not obligated to provide these vaccinations under essential services, so patients can seek them privately or through occupational health services.
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The Sale of Goodwill:
- Restrictions on the sale of goodwill pertain to medical practices with registered patient lists, affecting essential services. Doctors are generally advised not to treat registered patients privately, except where indicated.
- GPs can benefit from the sale of goodwill if they have shares in a company or co-operative without a registered patient list.
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Making Your Practice a Limited Company:
- Setting up a medical practice as a limited company may have tax advantages. Specialist accountancy advice is crucial before making this decision.
- Doctors in such a practice can contract with Clinical Commissioning Groups (CCGs) for GMS or PMS services.
- The salary drawn from the company can be pensioned in the NHS pension scheme, but dividends taken from the company are not pensionable.
- Doctors considering this approach should ensure their status is acceptable to NHS BSA and aligns with the organization's "not for profit" basis.
These are factual explanations of the concepts mentioned in the article. If you have any specific questions or need further details on any of these topics, please feel free to ask.
