What are the restrictions on seeing private patients in NHS practices?

The core rule: no charges to your own registered patients

Regulation 24 of the National Health Service (General Medical Services Contracts) Regulations 2015 says the contractor must not, “either itself or through any other person”, demand or accept a fee from any of its patients for:

• the provision of any treatment, “whether under the contract or otherwise”, or
• a prescription or repeatable prescription for any drug, medicine or appliance,

except in the circumstances listed in regulation 25. The words “or otherwise” matter. A practice cannot get round the rule by calling a service private or by saying the NHS contract does not cover it. If the patient is registered with the practice, the practice cannot charge them for treating them, apart from the listed exceptions.

The PMS Agreements Regulations 2015 contain the same prohibition (regulations 18 and 19), so the answer is the same whichever contract your practice holds.

What a practice can charge its own patients for

Regulation 25 is a closed list. The exceptions GPs meet most often are:

• travel immunisations for which the NHS pays nothing, and malaria prophylaxis
• medicines prescribed only in case the patient becomes ill while abroad
• medical reports and certificates requested by a third party, such as an insurer or employer, and examinations for those purposes
• examinations and advice requested by an employer or school, and services for a statutory body’s statutory functions
• fitness-to-travel reports and seat belt exemption examinations
• treatment of people who are not the practice’s patients

Some forms are now specifically protected: since October 2019 practices cannot charge their own patients for completing a mental health evidence form (used when patients are in debt) or for any related examination. The BMA publishes guidance on what practices can and cannot charge for, and it is updated as the regulations change.

Anything not on the list is off limits for the practice’s own patients. Services such as private blood test packages, longer private appointments or cosmetic minor surgery are treatment. A GMS practice cannot sell them to patients on its own list.

Seeing patients registered elsewhere

A practice can offer private services to people who are not its registered patients. Since October 2019 the contract has required that this happens:

• outside the hours the contractor has agreed to provide NHS primary medical services, and
• in no part of any practice premises for which NHS England makes premises payments.

There is a narrow exception that lets practices provide travel immunisations and malaria prophylaxis to non-patients on NHS-funded premises, outside core hours. The BMA also advises that NHS IT systems should not be used for private work.

Advertising private services

Paragraph 48C of Schedule 3 to the GMS Regulations says the contractor must not advertise private services, whether it provides them itself or another person does, by any written or electronic means it uses to advertise its NHS services. In practice, that means keeping private services out of the practice website, leaflet and any other channel you use to tell patients about NHS services.

Partners, salaried GPs and separate companies

The regulations bind the contractor, which may be a single GP, a partnership or a company. The BMA says:

• where the contractor is a sole practitioner or partnership, individual partners can only provide private primary medical services outside core hours
• where the contractor is a limited company, the restrictions apply to the company, not to the individual shareholder GPs.

The phrase “through any other person” means a practice cannot route private work for its own patients through a partner’s company, an associated clinic or another intermediary. Whether a salaried GP or a partner may see the practice’s own registered patients privately at a separate private clinic is not settled in the regulations. It also raises a conflict of interest under GMC guidance. The safe course is to avoid seeing your NHS practice’s registered patients privately, and to talk to your LMC, the BMA or your indemnity provider before setting up any arrangement.

When patients mix NHS and private care

Patients may combine NHS and private care. A patient seen privately elsewhere can still use NHS services, and you can refer or write to their NHS GP. Make sure the patient understands which parts of their care are private and paid for, and which are NHS. Send a summary of the private consultation to the NHS GP with the patient’s consent. See how to send consultation notes back to a patient’s NHS GP.

Scotland, Wales and Northern Ireland

The same core prohibition exists across the UK, but in different instruments with different exceptions:

Nation	Where the rule is
England	GMS Contracts Regulations 2015, regulations 24 and 25. PMS Agreements Regulations 2015, regulations 18 and 19.
Scotland	GMS Contracts (Scotland) Regulations 2018, regulation 28 and Schedule 5
Wales	GMS Contracts (Wales) Regulations 2023, regulations 21 and 22
Northern Ireland	GMS Contracts Regulations (Northern Ireland) 2004, regulation 24 and Schedule 4

The English rules on hours, premises and advertising were added by 2019 amendments that apply to England. Check the regulations for your nation, and ask your LMC, before relying on the English position.

A practical checklist

1. Never charge a patient registered with your NHS practice for treatment or a prescription unless it is on the regulation 25 list.
2. Run private work outside your contracted NHS hours and away from NHS-funded premises.
3. Keep private services out of practice NHS communications.
4. Keep separate records and systems for private work.
5. Get advice before you set up a company or clinic that could see your practice’s patients.