Consultant Psychiatrists are frequently asked to undertake Mental Health Act Assessments (MHAA). This work is undertaken on behalf of Local Authorities and is extra-contractual, except in certain well-defined circumstances largely relating to inpatients. The fees offered by Local Authorities for MHAAs have historically been inconsistent and continue to vary significantly on a regional and even a local basis.
For this reason, the BMA Consultants Committee has now developed a table to determine the minimum recommended payment consultant psychiatrists should expect when undertaking MHAAs. This is intended to create fairness and to ensure that appropriate fees are paid to reflect the value of consultants’ time. The same fees should be paid to any consultant who undertakes this skilled MHAA work , in line with the time at which the assessment is carried out. This is the case regardless of where the assessment takes place.
MHAAs may be completed by individual doctors, including consultant psychiatrists, trainee psychiatrists, general practitioners, and occasionally other doctors as extra-contractual work. However, the Consultants Committee has tailored this guidance specifically for section 12 doctors who are consultant psychiatrists. The objective of the guidance is to create a fee schedule that aligns with consultants’ high level of skill and expertise when undertaking MHAAs. These fees are a recommendation of the minimum remuneration consultants should be paid when asked to conduct these assessments. As such, they are not a pay ceiling and there may be situations where consultants negotiate higher rates for a variety of reasons. The recommended fees are set out in the table below.
| Time | Fee |
|---|---|
| Weekday: 7am - 7pm | £240 |
| Weekday: 7pm - 11pm | £315 |
| Weekend: 7am - 11pm | £315 |
| Overnight: 11pm - 7am | £405 |
| Travel | |
|---|---|
| 0 - 10 miles radius | No additional charge |
| 11 - 20 miles radius | £50 additional charge |
| 21+ miles radius | £100 additional charge |
| 31+ miles radius | £150 additional charge plus 45p per mile |
To allow for geographical variation of distances that might be commonly travelled for an assessment, we have set four bands of travel with additional fees recommended for the higher three categories. Again, consultants may wish to charge above the recommended fee depending on the specific circumstances of their travel requirements.
These fees have been calculated on the basis of the assessment being carried out at one specific location. Consequently, should further work at a separate location be required as part of the assessment process, an additional fee would be incurred (for example in a s135 assessment that then moves to a place of safety rather than being concluded at the initial location). Fees that are due must be paid by the appropriate authority within 28 days as per standard business arrangements.
The recommended fee varies depending on the day of the week and the time of day - ranging from £240 during the normal working week to £405 during the night.
What consultants can do
We want consultants to carefully consider whether the fees offered by a Local Authority for MHAAs are a fair representation of the skill level required, the time taken, and the realistic market value of those skills. We are asking consultants to advocate for these fair and benchmarked fees to undertake this work.
Unless doctors have entered into a specific agreement with their NHS employer, MHAAs undertaken outside of their place of work (i.e., not where patients are in-patients) are classed as fee-paying services, which are not part of their contractual duties. Doctors are therefore under no obligation to undertake them and may decline to do so unless the fees offered are acceptable to them.
Professional obligations
The responsibility for provision of MHAA services lies with the Local Authority and not individual doctors. Any decision by a doctor not to undertake a MHAA on request should not place a doctor in conflict with their obligations under the GMC’s Good Medical Practice.