Fee paying services

Fee paying services are services that are not part of contractual or consequential services and not reasonably incidental to them and so fees can be charged.

The principles below govern receipt of additional fees for doctors under the consultant contract for England (2004).

Schedule 10 fee-paying services

• Work on a person referred by a medical adviser of the Department for Work and Pensions, or by an Adjudicating Medical Authority or a Medical Appeal Tribunal, in connection with any benefits administered by an Agency of the Department for Work and Pensions.
• Work for the Criminal Injuries Compensation Board, when a special examination is required or an appreciable amount of work is involved in making extracts from case notes.
• Work required by a patient or interested third party to serve the interests of the person, his or her employer or other third party, in such non-clinical contexts as insurance, pension arrangements, foreign travel, emigration, or sport and recreation.
  
  (This includes the issue of certificates confirming that inoculations necessary for foreign travel have been carried out, but excludes the inoculations themselves. It also excludes examinations in respect of the diagnosis and treatment of injuries or accidents.)
• Work required for life insurance purposes.
• Work on prospective emigrants including X-ray examinations and blood tests.
• Work on persons in connection with legal actions other than reports which are incidental to the consultant's contractual and consequential duties, or where the consultant is giving evidence on the consultant's own behalf or on the employing organisation's behalf in connection with a case in which the consultant is professionally concerned.
• Work for coroners, as well as attendance at coroners' courts as medical witnesses.
• Work requested by the courts on the medical condition of an offender or defendant and attendance at court hearings as medical witnesses, otherwise than in the circumstances referred to above.
• Work on a person referred by a medical examiner of HM Armed Forces Recruiting Organisation.
• Work in connection with the routine screening of workers to protect them or the public from specific health risks, whether such screening is a statutory obligation laid on the employing organisation by specific regulation or a voluntary undertaking by the employing organisation in pursuance of its general liability to protect the health of its workforce.
• Occupational health services provided under contract to other NHS, independent or public sector employers.
• Work on a person referred by a medical referee appointed under the Workmen's Compensation Act 1925 or under a scheme certified under section 31 of that Act.
• Work on prospective students of universities or other institutions of further education, provided that they are not covered by contractual and consequential services. Such examinations may include chest radiographs.
• Examinations and recommendations under Part II of the Mental Health Act 1983 (except where the patient is an in-patient), where it follows examination at an out-patient clinic or where given as a result of a domiciliary consultation:

• if given by a doctor who is not on the staff of the hospital where the patient is examined
• if the recommendation is given as a result of a special examination carried out at the request of a local authority officer at a place other than a hospital or clinic administered by a NHS organisation.

• Services performed by members of hospital medical staffs for government departments as members of medical boards.
• Work undertaken on behalf of the Employment Medical Advisory Service in connection with research/survey work, ie the medical examination of employees intended primarily to increase the understanding of the cause, other than to protect the health of people immediately at risk (except where such work falls within contractual and consequential services).
• Completion of Form B (Certificate of Medical Attendant) and Form C (Confirmatory Medical Certificate) of the cremation certificates.
• Examinations and reports including visits to prison required by the Prison Service which do not fall within the consultant's contractual and consequential services and which are not covered by separate contractual arrangements with the Prison Service.
• Examination of blind or partially-sighted persons for the completion of form BD8, except where the information is required for social security purposes, or an Agency of the Department for Work and Pensions, or the Employment Service, or the patient's employer, unless a special examination is required, or the information is not readily available from knowledge of the case, or an appreciable amount of work is required to extract medically correct information from case notes.

Work undertaken by public health consultants, including services to a local or public authority of a kind not provided by the NHS, also count as fee paying services.

Services included

• Work as a medical referee (or deputy) to a cremation authority and signing confirmatory cremation certificates.
• Medical examination in relation to staff health schemes of local authorities and fire and police authorities.
• Lectures to other than NHS staff
  medical advice in a specialised field of communicable disease control.
• Work for water authorities, including medical examinations in relation to staff health schemes
  attendance as a witness in court.
• Medical examinations and reports for commercial purposes, eg certificates of hygiene on goods to be exported or reports for insurance companies.
• Advice to organisations on matters on which the consultant is acknowledged to be an expert.
• Examinations and recommendations under Part II of the Mental Health Act 1983.

Schedule 11 principles governing receipt of additional fees

In the case of the following services, the consultant will not be paid an additional fee, or ' if paid a fee ' the consultant must remit the fee to the employing organisation:

• any work in relation to the consultant's contractual and consequential services
• duties which are included in the consultant's job plan, including any additional programmed activities which have been agreed with the employing organisation
• fee paying work for organisations carried out during the consultant's programmed activities, unless the work involves minimal disruption and the employing organisation agrees that the work can be done in NHS time without the employer collecting the fee
• domiciliary consultations carried out during the consultant's programmed activities
• lectures and teaching during the course of the consultant's clinical duties
• lectures and teaching that are not part of the consultant's clinical duties, but are undertaken during the consultant's programmed activities.

Services for which the consultant can retain any fee that is paid

This list is not exhaustive but as a general principle the consultant is entitled to the fees for work done in his or her own time, or during annual or unpaid leave. For instance:

• fee paying services carried out in the consultant's own time, or during annual or unpaid leave
• fee paying services carried out during the consultant's programmed activities that involve minimal disruption to NHS work and which the employing organisation agrees can be done in NHS time without the employer collecting the fee
• domiciliary consultations undertaken in the consultant's own time, though it is expected that such consultations will normally be scheduled as part of programmed activities (and only for a visit to the patient's home at the request of a general practitioner and normally in his or her company to advise on the diagnosis or treatment of a patient who on medical grounds cannot attend hospital)
• private professional services undertaken in the employing organisation's facilities and with the employing organisation's agreement during the consultant's own time or during annual or unpaid leave
• private professional services undertaken in other facilities during the consultant's own time, or during unpaid leave
• lectures and teaching that are not part of the consultant's clinical duties and are undertaken in the consultant's own time or during annual or unpaid leave.