Chapter 8: When can fees be charged to a patient by a GP Practice?

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When can fees be charged to a patient by a GP Practice? (Extract)



This chapter contains:


1.     Introduction.

2.     The general prohibition on an NHS GP Practice charging fees to patients.

3.     Medical certificates that a GP practice must provide free of charge.

4.     Charges where the GP practice has reasonable doubts as to whether a patient is on the practice list.

5.     Charges permitted by Schedule 5 of the GMS Regulations and Schedule 3 of the PMS Regulations.

6.     Charges for meeting the requirements of other statutory bodies.

7.     Fees for conducting routine medical examinations.

8.     Services provided by a specialist GP for private patients in hospitals or a care home.

9.     Payment for emergency treatment of traffic casualties.

10.     Fees for attending a police station.

11.     Fees for preparing medical reports and issuing medical certificates.

12.     Fees for preparing medico-legal reports.

13.     Fees for preparing reports for seat belt purposes, following a traffic accident, a criminal assault or for fitness to travel.

14.     Eye examinations by GPs.

15.     Dispensing doctors and scheduled drugs.


1.             Introduction.


1.1          NHS services are generally free at the point of use for patients.  However the NHS has always imposed charges for some healthcare services and there are other functions undertaken by NHS doctors which are outside their NHS duties and hence attract a fee.  It follows that full legal position is somewhat more nuanced.   The general requirement that services should generally be provided free of charge is set out in section 1(4) of the National Health Service Act 2006 (“the NHS Act”) which provides:


The services provided as part of the health service in England must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under any enactment, whenever passed”


1.2          There are a number of areas where Regulations provide that charges may be imposed for NHS services including:


a)             Prescriptions;

b)             Dental services;

c)              Optical services;

d)             Contraceptive services;

e)             Hospital services for persons who are not usually ordinarily resident in the UK.


1.3          Primary care services provided under a GMS[1] or PMS[2] contract to patients on the practice list or temporary residents are required to be provided free of charge.  The GMS and PMS contracts also provide that GP practices have a contractual obligation to provide a range of other services to patients[3].   However GP practices are (almost all) private sectors businesses that have contracted with NHS England to provide defined primary care services to a defined group of patients and to provide defined level of emergency medical services in limited circumstances.  If a registered patient or temporary resident[4] seeks primary care services from an NHS GP practice outside the terms of the contract held by that practice, the NHS GP practice has no obligation to provide services to that person.  However the GP practice cannot charge for treatment provided outside the GP Practice contract unless the service falls within a limited categories of specific services.


2.             The general prohibition on an NHS GP Practice charging fees to patients.


[1] GMS stands for “General Medical Services”.  It is the default form of agreement for GP practices.  For details of the different types of contracts that a GP practice can hold please see chapter 3.

[2] PMS stands for “Personal Medical Services”, a form of GP Practice contract originally brought in by the National Health Service (Primary Care) Act 1997.  For details please see chapter 3.

[3] Please see chapter 7 for details of the range of services that a GMS or PMS practice is obliged to provide.

[4] Please see chapter 6 for details about how GP practice lists work and the persons to whom a GP is obliged to provide services.

David Lock QC

David Lock QC is a barrister at the Landmark Chambers.

180 Fleet Street
London, EC4A 2HG
DX 1042 (London)

He was called to the Bar in 1985 and was appointed Queens Counsel in 2011.

David Lock QC is Head of the Administrative & Public Law Group and the Judicial Review & high Court Challenges Group at No5 Chambers. - See more at:

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