When can GPs charge patients a fee?

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The regulations governing this are Schedule 5 of the National Health Service (General Medical Services Contracts) Regulations 2004, which state:

:469 The Contractor shall not, either itself or through any other person, demand or accept from any patient of its a fee or other remuneration for its own or another’s benefit-

469.1or the provision of any treatment whether under the Contract or otherwise, or
469.2 for any prescription or repeat prescription for any drug, medicine or appliance,
except in the circumstances set out in clause 470.
470 The Contractor may demand or accept a fee or other remuneration—
470.1 from any statutory body for services rendered for the purposes of that body’s statutory functions;
470.2 from any body, employer or school for a routine medical examination of persons for whose welfare the body, employer or school is responsible, or an examination of such persons for the purpose of advising the body, employer or school of any administrative action they might take;
470.3 for treatment which is not primary medical services or otherwise required to be provided under the Contract and which is given-
470.3.1 pursuant to the provisions of section 65 of the Act, or
470.3.2 in a registered nursing home which is not providing services under that Act,
if, in either case, the person administering the treatment is serving on the staff of a hospital providing services under the Act as a specialist providing treatment of the kind the patient requires and if, within 7 days of giving the treatment, the Contractor or the person providing the treatment supplies the LHB, on a form provided by it for the purpose, with such information about the treatment as it may require;
470.4 under section 158 of the Road Traffic Act 1988;
470.5 when it treats a patient under clause 471, in which case it shall be entitled to demand and accept a reasonable fee from the patient (recoverable in certain circumstances under clause 472) for any treatment given, if it gives the patient a receipt;
470.6 for attending and examining (but not otherwise treating) a patient-
470.6.1 at his request at a police station in connection with possible criminal proceedings against him,
470.6.2 at the request of a commercial, educational or not-for-profit organisation for the purpose of creating a medical report or certificate, or
470.6.3 for the purpose of creating a medical report required in connection with an actual or potential claim for compensation by the patient;
470.7 for treatment consisting of an immunisation for which no remuneration is payable by the LHB and which is requested in connection with travel abroad;
470.8 for prescribing or providing drugs, medicines or appliances (including a collection of such drugs, medicines or appliances in the form of a travel kit) which a patient requires to have in his possession solely in anticipation of the onset of an ailment or occurrence of an injury while he is outside the United Kingdom but for which he is not requiring treatment when the medicine is prescribed;
470.9 for a medical examination to enable a decision to be made whether or not it is inadvisable on medical grounds for a person to wear a seat belt, or for the purpose of creating a report relating to a road traffic accident or criminal assault, or that offers an opinion as to whether a patient is fit to travel;
470.10 for testing the sight of a person to whom none of paragraphs (a), (b) or (c) of section 38(1) of the Act applies (including by reason of regulations under section 38(6) of that Act);
470.11 where the Contractor is authorised or required by a Local Health Board under regulation 20 of the Pharmaceutical Regulations or clauses 306 to 315 to provide drugs, medicines or appliances to a patient and provides for that patient, otherwise than by way of pharmaceutical services or dispensing services, any Scheduled drug;
470.12 for prescribing or providing drugs for malaria chemoprophylaxis.
471 Where a person applies to the Contractor for the provision of essential services and claims to be on the Contractor’s list of patients, but fails to produce his medical card on request and the Contractor has reasonable doubts about that person’s claim, the Contractor shall give any necessary treatment and shall be entitled to demand and accept a reasonable fee in accordance with clause 470.5 subject to the provision for repayment contained in clause 472.
472 Where a person from whom the Contractor received a fee under clause 470.5 applies to the LHB for a refund within 14 days of payment of the fee (or such longer period not exceeding a month as the LHB may allow if it is satisfied that the failure to apply within 14 days was reasonable) and the LHB is satisfied that the person was on the Contractor’s list of patients when the treatment was given, the LHB may recover the amount of the fee from the Contractor, by deduction from its remuneration or otherwise, and shall pay that amount to the person who paid the fee.
473 Part 18 shall survive the expiry or termination of the Contract to the extent that it prohibits the contractor from, either itself or through any other person, demanding or accepting from any patient of it’s a fee or other remuneration for its own or another’s benefit .
473.1 for the provision of any treatment, whether under the Contract or otherwise, that was provided during the existence of the Contract; or
473.2 for any prescription or repeat prescription for any drug, medicine or appliance, that was provided during the existence of the Contract”.

So GPs cannot charge their patients for DNA's or for pregnancy tests, or for issuing a private prescription, or for providing a private referral letter or anything else that is not specifically mentioned here as being chargeable.

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