Over the past months I have had several enquiries from practices and LMCs on the theme of private work and how GPs can do more of it. So what are the constraints on GPs doing private work and can one get round them?
With a few limited exceptions, GPs cannot charge their registered patients for anything. The exceptions are listed in Schedule 5 of the GMS Regulations and include things such as travel vaccinations or certain medical reports. But, in short, if it's not on the list, partners/practices can't charge their registered patients for it.
However, it is possible for partners and practices to charge people who aren't their registered patients. GPs are entitled to charge people who aren't on their practice's list for anything they want. However, they can't provide the relevant service at reimbursed premises. If they do, they risk the practice's notional rent being abated. This is true even if the service is carried out "out of hours" at a time the practice wouldn't be using the surgery anyway. This position may seem unduly restrictive but the new Premises Costs Directions, issued in May 2024, have done nothing to change the position.
In theory, two practices could set up a 'buddy system', whereby patients registered with practice A can be seen privately at practice B, and vice versa. However, there are constraints even on this, practice A can't force (or even direct) its patients to use practice B. If practice A gets any financial benefit from sending its patients to practice B, it risks falling foul of the restriction on accepting a benefit ‘through any other person’ (which is prevented by Regs 24(2) of the GMS Regs).
So, a GP (or a partnership) wishing to set up a non-NHS service must ensure they don’t treat any of their own patients, and they have to find their own premises to do so.
The most important question is – 'is it going to be worth it?' It's not just a case of ensuring that a private service is profitable – after taking into account premises costs, the additional costs of staff, extra insurance, CQC registration requirements, advertising etc. To run a private service, a partner will likely need to reduce their GMS hours. The key consideration is whether the income from the private service will exceed the income from working those hours in the practice. In many cases the answer to this will be 'no'. If the private service is going to be worth doing, it doesn't just have to be profitable – it has to be more profitable than spending x hours per week doing normal GMS work.
Oliver Pool (opool@vwv.co.uk and 0117 314 5429) is a partner in the healthcare team at VWV and a member of the ICAEW Healthcare Community.
*The views expressed are the author's and not ICAEW's
