What is non-NHS work and why is there a fee?
The NHS provides the majority of healthcare services free of charge. However, some services fall outside the NHS contract agreed between GP practices and the Government. These are known as non-NHS or private services and are not funded by the NHS.
GP practices are independent businesses contracted to provide NHS medical services. Work that falls outside this contract must therefore be completed privately and may attract a fee to cover clinical time and administrative costs.
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, doctors have increasingly been asked to complete forms or provide letters for administrative, legal, insurance, employment, housing, and educational purposes. These requests are often made because GPs are considered trusted professionals — not because the task is medical in nature.
Examples of non-NHS services for which GPs can charge their own NHS patients are:
- Accident or sickness certificates for insurance purposes
- Holiday cancellation or school fee insurance certificates
- Private prescriptions (e.g. travel vaccinations not available on the NHS)
- Copies of medical records (beyond standard Subject Access Requests)
- Medical reports requested by third parties.
Examples of non-NHS services for which GPs can charge other institutions are:
- Life assurance and income protection reports
- Reports for the Department for Work and Pensions (where appropriate)
- Medical reports for adoption and fostering.
- Legal reports for solicitors
- Occupational health reports
Do GPs have to do non-NHS work for their patients?
With very limited exceptions, GPs are not contractually required to undertake non-NHS work.
One key exception is where legislation requires confirmation of medical unfitness, for example:
- Jury Service exemption letters (where a patient is medically unfit to attend) Outside of such statutory obligations, GPs are not required to provide private letters or complete non-NHS forms.
While we aim to be helpful, the practice must prioritise NHS clinical care.
Services the Practice Does Not Provide
To ensure clarity and fairness, the practice does not provide the following:
- Housing support letters
- Letters to landlords or housing associations
- Letters for university, college, or school mitigation requests
- Accommodation letters
- General “to whom it may concern” letters.
- Character references
- Private fitness certificates (including gym, sports, travel, modelling, acting)
- Firearms application reports
- Fitness to fly certificates.
These requests are not part of NHS GP services, and we are unable to provide them.
If documentation is required for housing or educational purposes, organisations should rely on existing medical records or seek alternative professional assessment where appropriate.
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 (ie 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.
When can I expect my request to be completed?
Please be advised that Subject Access Requests (full medical history) will be completed within 21 days. All other private work requests will be completed within 56 working days. 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 doesn’t 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 person’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 lists of fees based on these suggested fees. Please ask at reception.
What can I do to help?
- Read the information that comes with these types of forms carefully before requesting your GP to complete them.
- Passport photos – please note that these can no longer be verified by your GP or nurse, as they know you in a professional capacity.
- 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.
Please note that the doctors at the practice do not undertake the following:
- Fitness to fly certificates
- Fitness to travel examination
- Fitness for sports/activities/gym memberships
- Fitness for acting or modelling
- Reports for firearms applications
These will need to be undertaken by an accredited private physician.
Private Referrals
Please see full guidance about Private Referrals at our FAQ page.