Which private services can I offer to patients registered at my practice?

A correction

An earlier version of this article said a practice could charge its registered patients for all the services it would provide in the NHS, and for services outside the NHS contract such as cosmetic minor surgery. That was wrong, and following it could put an NHS contract at risk. This version replaces it.

The rule

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 any treatment, whether under the contract or otherwise, or for a prescription. The only exceptions are the circumstances in regulation 25. PMS agreements contain the same prohibition. The full rule, including hours, premises and advertising, is covered in the restrictions on seeing private patients in NHS practices. This article looks at what that means for the services patients actually ask for.

What you can charge your own patients for

Regulation 25 is a closed list. The items practices use most often are:

• Travel immunisations the NHS does not pay for. On the NHS website, hepatitis B for travel, Japanese encephalitis, rabies, tick-borne encephalitis and yellow fever are listed as vaccines patients usually pay for. Yellow fever can only be given at a designated Yellow Fever Vaccination Centre.
• Malaria prophylaxis. Prescribing or providing antimalarials.
• Standby medicines for travel. Medicines the patient needs to have only in case they become ill while outside the UK.
• Reports and certificates for third parties. Examining a patient to produce a report or certificate requested by a commercial, educational or not-for-profit organisation, such as an insurer.
• Employer and school examinations. Routine medicals requested by a body, employer or school responsible for the person.
• Specific reports and examinations. Fitness-to-travel reports, seat belt exemption examinations, reports on road traffic accidents or assaults, and reports for compensation claims.
• Services for statutory bodies. Work done for a statutory body’s statutory functions.

Some forms are protected. Since October 2019 practices in England cannot charge their own patients for completing a mental health evidence form used in debt cases, or for any related examination.

What you cannot charge your own patients for

Patients often ask for	Can the practice charge its own patient?
Blood tests or a health check on request	No. It is treatment.
A longer or faster appointment	No.
Minor surgery, including cosmetic procedures	No.
A private prescription, including for a medicine not usually prescribed on the NHS	No, except antimalarials and travel standby medicines.
Hepatitis A, typhoid, cholera or polio travel vaccines	No. These are NHS-funded.
Rabies or yellow fever vaccine for travel	Yes.
An insurance medical report	Yes, when the insurer requests it.

If a patient wants something you cannot charge for, you can provide it on the NHS if it is clinically appropriate, or explain that they can get it privately from an unconnected provider. Do not steer them to a private service you or your partners have an interest in, as that would be charging "through any other person" and raises a conflict of interest under GMC guidance. See handling conflicts of interest.

Offering private services to people registered elsewhere

A practice can offer private services to people who are not its registered patients. In England that must be outside its contracted NHS hours and not in premises for which NHS England makes premises payments, apart from a narrow exception for travel vaccines and malaria prophylaxis. Private services must also not be advertised through the channels the practice uses for NHS services.

That is why many GPs who want to do private work do it through a separate service at separate premises, for patients who are not on their NHS practice’s list. See who you can see as a private GP.

Who the rules bind

The regulations bind the contractor: a sole GP, a partnership or a company. The BMA’s view is that where the contractor is a partnership, partners can only provide private primary medical services outside core hours, and that where the contractor is a company, the restrictions apply to the company. How the rules apply to salaried GPs and to separate companies owned by partners is less settled. Take advice from your LMC, the BMA or your medical defence organisation before setting anything up.

Scotland, Wales and Northern Ireland

Each nation has its own GMS regulations with a similar prohibition and its own list of exceptions. The English rules on hours, premises and advertising were added in 2019 and apply in England. Check the regulations for your nation before relying on this article.