What is non-NHS work and why is there a fee?

The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951 and there are a number of other services for which fees are charged.

Sometimes the charge is because the service is not covered by the NHS, for example, providing copies of health records or producing medical reports for insurance companies, solicitors or employers.

The Government’s contract with GPs covers medical services to NHS patients but not non-NHS work. It is important to understand that many GPs are not employed by the NHS; they are self-employed and they have to cover their costs – staff, buildings, heating, lighting, etc. – in the same way as any small business.

In recent years, however, more and more organisations have been involving doctors in a whole range of non-medical work. Sometimes the only reason that GPs are asked is that they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.

Examples of non-NHS services for which GPs can charge their own NHS patients are:

• Accident/sickness certificates for insurance purposes
• School fee and holiday insurance certificates
• Reports for health clubs to certify that patients are fit to exercise
• Private prescriptions for travel purposes

Examples of non-NHS services for which GPs can charge other institutions are:

• Life assurance and income protection reports for insurance companies
• Reports for the Department for Work and Pensions (DWP) in connection with
• Disability living allowance and attendance allowance
• Medical reports for local authorities in connection with adoption and fostering
• Copies of records for solicitors

Do GPs have to do non-NHS work for their patients?

With certain limited exceptions, for example, a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients. Whilst GPs will always attempt to assist their patients with the completion of forms, they are not required to do such non-NHS work.

Is it true that the BMA sets fees for non-NHS work?

The British Medical Association (BMA) suggest fees that GPs may charge their patients for non-NHS work (i.e. work not covered under their contract with the NHS) in order to help GPs set their own professional fees. However, the fees suggested by them are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates they suggest.

Why does it sometimes take my GP a long time to complete my form?

Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients. Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time. Our GPs do non-NHS work out of NHS time at evenings or weekends so that NHS patient care does suffer.

I only need the doctor’s signature – what is the problem?

When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient’s entire medical record. Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the police.

If you are a new patient we may not have your medical records so the doctor must wait for these before completing the form.

What will I be charged?

It is recommended that GPs tell patients in advance if they will be charged, and what the fee will be. It is up to individual doctors to decide how much they will charge. The surgery has a list of fees based on these suggested fees which are available on request.

What can I do to help?

Not all documents need a signature by a doctor, for example, passport applications. You can ask another person in a position of trust to sign such documents free of charge. Read the information that comes with these types of forms carefully before requesting your GP to complete them.

If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.

Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this may cost more. Usually, non-NHS work will take 2 weeks.

All GP practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice.

The average pay for GPs working in The Vale Surgery in the last financial year was £66,958.00 before tax and National Insurance. This is for 2 full time GPs and 1 locum GP who worked in the practice for more than 6 months.

It should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to from any judgement about GP earnings, nor to make any comparison with any other practice.

What information do we collect about you?

We only collect the information (“data”) that we need to help us keep you healthy – such as your name, address, next of kin, records of appointments, visits, telephone calls, your health record, treatment and medicines, test results, X-rays and any other information to enable us to care for you.

How do we use your information?

• We share your medical records with other health professionals who are involved in providing you with care and treatment. This is only ever on a need-to-know basis and event by event.
• Some of your data is automatically copied to the Shared Care Summary Record.
• We share some of your data with local out-of-hours provider
• Data about you is used to manage national screening campaigns such as flu, cervical cytology and diabetes prevention.
• Your data about you is used to manage the NHS and make payments.
• We share information when the law requires us to, for instance when we are inspected or reporting certain illnesses or safeguarding vulnerable people
• Your data is used to check the quality of care provided by the NHS.
• We may also share medical records for medical research

How to access your records?

We encourage patients to sign up to online services (Patient Access) where you can also access your medical records. Please ask our receptionist for more details.

If you want to see what is written about you, you have a right to access the information we hold on you, but you will need to complete a form called Subject Access Request (SAR). Please ask at reception for a SAR form and you will be given further information. You can request to view only certain parts of your records if you prefer.

Furthermore, should you identify anything in your record which is incorrect,  you have the right to have the inaccurate data corrected.

Processors of personal data

In order to deliver the best possible service, the practice contracts Processors to process personal data, including patient data on our behalf.

When we use a Processor to process personal data we will always have an appropriate legal agreement in place to ensure that they keep the data secure, that they do not use or share information other than in accordance with our instructions and that they are operating appropriately. Examples of functions that may be carried out by a Processor include:

• Companies that provide IT services & support, including our core clinical systems; systems which manage patient facing services (such as our website and service accessible through the same); data hosting service providers; systems which facilitate appointment bookings or electronic prescription services; document management services etc.
• Delivery services (for example if we were to arrange for delivery of any medicines to you).
• Payment providers (if for example you were paying for a prescription or a service such as travel vaccinations).

Don’t want to share?

All our patients can choose not to share their information. Should you wish to opt out of data collection, please contact a member of staff, alternatively,

Patients can set their opt-out preferences at www.nhs.uk/your-nhs-data-matters You will need their NHS number and a valid email address or telephone number which is on the GP record or on the Personal Demographics Service database to register their decision to opt out. Patients who are unable to use the online facility can use a phone helpline to manage their choice 0300 303 5678. A paper print-and-post form is also available at www.nhs.uk – Other ways to make a choice about sharing data.

Alternatively, please contact a member of staff for support.

Have a question?

If you have any questions, ask a member of the surgery team. You can:

Contact the practice’s data controller via email at lamccg.exchangesurgeryreceptionnhs@nhs.net. GP practices are data controllers for the data they hold about their patients

Ask to speak to the practice manager Lucie Lehane who is also Data Protection Champion for The Exchange Surgery.

Data Protection Officer (DPO) contact for The Exchange Surgery:

IG Help Desk Contact:

• Email: nelcsu.dpo@nhs.net, nelcsu.information-governance@nhs.net
• Telephone: 030000 428 438

GP DPO Service Lead: Claire Clements

If you’re not happy about how we manage your information

We really want to make sure you’re happy, but we understand that sometimes things can go wrong. If you are unhappy with any part of our data-processing methods, you can complain. For more information, visit ico.org.uk and select ‘Raising a concern’.

We always make sure the information we give you is up-to-date. Any updates will be published on our website, in our newsletter and leaflets, and on our posters. This policy will be reviewed in May 2019.

For more information see Our Healthier South East London Privacy Notice.

The practice complies with the Data Protection Act 2018. All information about patients is confidential: from the most sensitive diagnosis to the fact of having visited the surgery or being registered at the practice. All patients can expect that their personal information will not be disclosed without their permission except in the most exceptional of circumstances when somebody is at grave risk of serious harm.

All members of the primary health care team (from reception to doctors) in the course of their duties will have access to your medical records. They all adhere to the highest standards of maintaining confidentiality.

As our reception area is a little public, if you wish to discuss something of a confidential nature please mention it to one of the receptionists who will make arrangements for you to have the necessary privacy.

Under 16s

The duty of confidentiality owed to a person under 16 is as great as the duty owed to any other person. Young people aged under 16 years can choose to see health professionals, without informing their parents or carers. If a GP considers that the young person is competent to make decisions about their health, then the GP can give advice, prescribe and treat the young person without seeking further consent.

However, in terms of good practice, health professionals will encourage young people to discuss issues with a parent or carer. As with older people, sometimes the law requires us to report information to appropriate authorities in order to protect young people or members of the public.

Useful Websites

• Confidentiality NHS Code of Practice
• Confidentiality and Mental Health
• Confidentiality Guidance

There are occasions when the doctor or nurse needs to give you a full examination.

• All patients are entitled to have a chaperone with them for any physical examination.
• The chaperone can be a family member, friend or a member of staff.
• If you want a member of staff to accompany you during the visit please let the receptionist know when you arrive for your appointment.

All patients are entitled to have a chaperone present for any consultation, examination or procedure. If you would like a chaperone, however have not been offered one, please ask your GP, nurse or enquire at reception.

If we can’t provide someone straight away, you may need to return for the examination.