Card Payments for NHS GP Practices: Private Fees, Reports & Chargeable Services

GP Practice Payments: The Quick Answer

NHS GP practices provide NHS-funded care free at the point of use, but not every service requested from a GP practice forms part of NHS-funded primary medical services.

Practices can therefore receive payments for certain permitted non-NHS and chargeable services.

Examples may include:

• medical reports requested by patients or third parties;
• insurance reports;
• certain certificates and letters;
• occupational or employment-related medical work;
• some private medical examinations;
• travel-related documentation;
• certain travel vaccinations that are not provided free through the NHS;
• other permitted non-NHS administrative work; and
• services provided privately where the relevant NHS contractual rules allow it.

The payment requirement is therefore very different from that of a fully private clinic. 

This guide focuses specifically on payments for permitted non-NHS work within GP practices. For the wider healthcare payments landscape, including private clinics, dentists, vets, opticians and aesthetics businesses, read our Healthcare Payment Solutions UK guide.

An NHS GP practice usually needs a straightforward way to identify a chargeable service, tell the patient or requesting organisation what it costs, collect the correct payment and reconcile it separately from NHS-funded income.

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Who Is This Guide For?

This guide is primarily for:

• NHS GP partnerships;
• GP surgery practice managers;
• business managers;
• finance teams within general practice;
• primary-care organisations collecting permitted private fees;
• GP practices offering private travel-health services where permitted;
• practices reviewing how they collect fees for reports and certificates; and
• multi-site GP organisations that need better reporting of non-NHS income.

It is not intended as a guide to running a separate private GP clinic.

For doctors, consultants and clinics operating privately, read our Private Healthcare Merchant Accounts & Payment Solutions for Doctors and Clinics guide.

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Can NHS GP Practices Charge Patients?

Yes, but only in circumstances where charging is permitted.

NHS-funded primary medical services should not simply be converted into private paid services for registered NHS patients.

The BMA's current guidance explains that Regulations 24 and 25 of the General Medical Services Regulations govern the circumstances in which NHS GP practices can and cannot charge fees.

Broadly, a registered or temporary patient cannot normally be charged for treatment that the practice is required to provide under its NHS contract.

However, GP practices can charge for certain services outside NHS-funded treatment, subject to the relevant contractual and regulatory rules.

This makes it important for practices to distinguish:

NHS-funded care from genuinely chargeable non-NHS work.

What Types of Work Can Generate Private Fees in an NHS GP Practice?

Chargeable activity varies between practices, but common examples can include work performed because a patient, employer, insurer or another third party requires information or a service that is not funded through the normal NHS GP contract.

That can create income from several different sources.

Patient-funded work

The patient may pay the practice directly for a permitted service.

Insurance companies

An insurer may request information or a medical report and pay the practice for completing it.

Employers

An employer or occupational-health organisation may request certain reports or examinations.

Other third parties

Solicitors, financial organisations and other authorised organisations may request information or reports, subject to the appropriate consent and legal requirements.

The payment process needs to identify not just what was paid, but also who was responsible for paying it.

Medical Reports and GP Practice Payments

Medical reports are one of the clearest examples of non-NHS work carried out by GP practices.

Producing a report can require the doctor to:

• review the medical record;
• identify relevant information;
• consider the purpose of the request;
• complete forms;
• prepare a report or letter;
• check its accuracy; and
• ensure appropriate consent and disclosure requirements are followed.

The BMA explains that this work takes professional and administrative time and is not necessarily funded by the NHS.

The practice may therefore charge an appropriate fee where permitted.

Insurance Reports and Certificates

Insurance-related work can be another source of private-fee income.

Examples can include requests connected to:

• life insurance;
• income protection;
• private medical insurance;
• travel insurance claims;
• other insurance applications; and
• reports following illness abroad.

BMA guidance states that some insurers offer fees for GP reports, but practices can determine their appropriate private rate for certain work.

The payment arrangement should make clear whether:

• the patient pays;
• the insurance company pays;
• payment is required before the report is completed; or
• the organisation will be invoiced.

Certificates, Letters and Forms

GP practices are also regularly asked to provide letters, certificates and forms that sit outside routine NHS care.

The precise charging position depends on the nature of the request, so practices should check current NHS, BMA and contractual guidance before setting a fee.

Where a fee is permitted, the payment process should make it easy for administrative staff to identify:

• which document has been requested;
• who requested it;
• the agreed charge;
• whether payment has been received;
• whether the GP has completed the work; and
• whether anything remains outstanding.

Occupational and Employment-Related Work

GPs may also receive requests connected to employment or occupational requirements.

Depending on the precise circumstances, this can involve work outside the normal NHS GP contract.

For payment purposes, practices should establish:

• who has requested the work;
• whether the service is chargeable;
• who is responsible for the fee;
• whether payment is required in advance;
• whether VAT or other tax considerations need professional advice; and
• how the income should be recorded within the practice accounts.

The purpose of this article is payment collection rather than determining whether a particular medical service is chargeable.

Practices should confirm the relevant contractual and professional rules before charging.

Travel Vaccinations: Some Are NHS-Funded and Some Are Chargeable

Travel health is one of the areas where payment rules can be particularly confusing.

Some travel vaccinations are available through NHS provision, while others normally require payment when given solely for travel.

Travel vaccinations available free through the NHS

Current NHS guidance lists the following as travel vaccinations available free through NHS services where clinically indicated and the relevant service is provided:

• cholera;
• polio, usually provided through the combined tetanus, diphtheria and polio vaccine;
• hepatitis A; and
• typhoid.

A GP practice should not charge a registered patient for an NHS-funded vaccination simply because it is related to travel.

Travel vaccinations that normally require payment

NHS guidance currently identifies a number of travel vaccinations that are not routinely available free through the NHS when required solely for travel.

Examples include:

• hepatitis B;
• Japanese encephalitis;
• rabies;
• tick-borne encephalitis; and
• yellow fever, which is only available through designated vaccination centres.

Other travel vaccines may also fall outside NHS provision depending on the circumstances.

Patients can obtain chargeable travel vaccinations from private travel clinics, pharmacies providing travel-health services or GP surgeries that choose to offer the relevant private service.

The exact vaccination and charging rules should always be checked against current NHS and BMA guidance.

Taking Payment for Private Travel Vaccinations

Where a GP surgery legitimately provides a chargeable private travel vaccination, the payment could potentially include:

• the vaccine itself;
• administration;
• a private prescription where relevant;
• certification where appropriate; and
• other associated private-service charges where permitted.

The total price should be explained before the patient commits to the service.

The practice should also distinguish these private transactions clearly from NHS-funded vaccination activity.

Do Not Mix NHS and Private Charges

This is probably the most important operational principle for this page.

An NHS GP practice may receive income from many different sources, but the fact that a card machine can accept a payment does not mean that every service can legitimately be charged for.

Staff should have clear internal guidance covering:

• which services are NHS-funded;
• which services the practice has determined are legitimately chargeable;
• the approved fees;
• who is responsible for payment;
• when payment should be taken;
• how it should be recorded; and
• who can approve exceptions or refunds.

The payment system should support the practice's policy rather than determine it.

Should GP Practices Display Their Private Fees?

Clear fee information can reduce confusion at reception.

Where a practice performs non-NHS work, it can be useful to maintain an up-to-date fee schedule covering the services it chooses to provide privately.

This might include:

• the name of the service;
• the current fee;
• whether VAT is included where applicable;
• whether payment is required in advance;
• estimated completion times where appropriate;
• who should pay; and
• how payment can be made.

The BMA provides a fees calculator for members carrying out non-contracted work and stresses the importance of considering the real administrative and professional cost involved.

When Should the Practice Take Payment?

For some types of non-NHS work it may make sense to collect payment before the work begins.

This avoids the practice spending administrative or GP time preparing a report and then having to chase the fee afterwards.

A simple workflow might be:

1. request received;
2. practice confirms the work can be undertaken;
3. fee confirmed;
4. payment request sent;
5. payment received;
6. work allocated to the appropriate clinician;
7. report or document completed; and
8. transaction reconciled against the request.

Third-party organisations may operate on an invoice basis instead, so practices may need more than one collection method.

Card Machines for GP Surgeries

A card machine is often the simplest way to collect private fees when the patient is physically at the surgery.

Examples could include payment for:

• a chargeable travel vaccination;
• a permitted certificate;
• a private report;
• another agreed non-NHS service; or
• a balance that has already been confirmed by the practice.

When selecting a terminal, practices should consider:

• ease of use for reception staff;
• transaction charges;
• refund controls;
• settlement;
• daily transaction reporting;
• PCI DSS requirements;
• terminal rental;
• contract length; and
• how easily the transaction can be reconciled with the relevant private service.

Payment Links Can Be Particularly Useful for GP Practices

Many non-NHS requests do not require the patient to be standing at reception when payment is made.

A secure payment link can therefore be useful.

The practice can send a link by text message or email and the customer enters their own card details on the provider's hosted payment page.

Payment links can potentially be used for:

• medical reports;
• insurance forms;
• certificates;
• travel-health payments;
• other non-NHS administrative work;
• outstanding private fees; and
• payments being made by another authorised person.

This can reduce the need for reception staff to handle card details directly.

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Payment Links Can Also Support Payment Before Work Starts

This is potentially one of the most useful workflows for chargeable GP work.

Rather than telling the patient to visit the surgery or telephone reception to make payment, the practice could:

1. confirm the service and fee;
2. send a secure payment link;
3. receive confirmation of payment;
4. record the transaction;
5. begin the chargeable work; and
6. complete the document or service.

For a busy practice, this can remove several manual steps from the process.

Telephone Payments and Virtual Terminals

Some practices may still need to accept payment by telephone.

A patient or third party may call reception and ask to settle a private fee using a debit or credit card.

These card-not-present transactions may require an approved MOTO or virtual-terminal facility.

Practices should compare:

• MOTO transaction pricing;
• PCI DSS implications;
• staff permissions;
• fraud controls;
• reporting;
• refunds; and
• whether a secure payment link could be used instead.

Invoices to Insurers, Employers and Other Organisations

Not every chargeable service is paid directly by a patient.

Some work is requested by organisations such as insurers or employers.

The practice may therefore need to issue an invoice and wait for payment through that organisation's normal accounts process.

This creates a different reconciliation requirement from an immediate card payment.

The practice should ideally be able to identify:

• requesting organisation;
• patient concerned;
• type of report or service;
• invoice number;
• fee;
• date invoiced;
• date paid;
• payment method; and
• outstanding balance.

Separating NHS Income From Private-Fee Income

NHS contract income and patient or third-party private fees arise through different routes.

The practice's accounting and reporting should therefore make it possible to identify its private-fee income separately.

This can help with:

• management accounts;
• practice-partnership reporting;
• tax and VAT review;
• understanding which private services generate income;
• identifying unpaid fees;
• reconciling merchant settlements; and
• reviewing whether private work is commercially worthwhile.

Practices should obtain professional accounting or tax advice on the treatment of their individual services rather than assuming all healthcare-related income is treated identically.

GP Practice Software and Payment Reconciliation

GP practices already operate complex clinical and administrative systems.

The payment system does not necessarily need direct access to clinical information to be useful.

In many cases the practice simply needs a reliable reference that allows staff to identify:

• the person or organisation paying;
• the service concerned;
• the amount;
• the payment date;
• the payment method;
• whether a refund was issued; and
• whether the request has been completed.

Payment references should avoid containing unnecessary clinical information.

Patient Data and Card Data Should Be Treated Separately

A GP practice handles highly sensitive health information.

Payment providers do not need unrestricted access to a patient's clinical record simply to process a card transaction.

Practices should understand what information moves between:

• clinical systems;
• practice administration systems;
• payment providers;
• accounting software;
• email and SMS systems; and
• third-party organisations requesting reports.

Only information genuinely required for the payment or administrative process should be included.

PCI DSS and GP Practice Card Payments

GP practices accepting cards should also understand the relevant PCI DSS requirements.

The card-data environment can vary depending on whether the practice uses:

• a standalone card terminal;
• a hosted payment link;
• an online payment page;
• a virtual terminal; or
• telephone card payments.

PCI DSS relates to card-payment security. It should not be confused with the separate requirements governing medical records and patient health information.

Refunds for Chargeable GP Services

A practice should have a clear refund process for private transactions.

Examples might include:

• a payment being taken twice;
• a report no longer being required;
• the practice deciding it cannot complete the requested work;
• a private service being cancelled;
• an incorrect fee being charged; or
• another agreed reason for repayment.

The merchant system should allow authorised staff to locate the original payment and process an appropriate refund.

Practices should also decide which employees have permission to issue refunds.

Multi-Site GP Practices and Primary Care Organisations

Larger GP organisations may operate across several surgeries.

Where private fees are collected at multiple locations, the business may want to identify:

• which practice generated the fee;
• which location took payment;
• which legal entity received the income;
• daily transaction totals;
• refunds;
• outstanding private work;
• settlement by site; and
• group-level private-fee income.

A centralised merchant agreement may be appropriate in some structures, while others may require separate merchant arrangements.

The provider should understand the actual legal and operational structure before accounts are created.

How Much Does Card Processing Cost a GP Practice?

Payment-provider costs can include more than a single card percentage.

Possible charges include:

• percentage transaction fees;
• fixed transaction charges;
• terminal rental;
• gateway or payment-link fees;
• MOTO charges;
• PCI-related fees;
• refund fees;
• chargeback fees;
• monthly minimum charges; and
• contract termination costs.

For relatively low volumes of private transactions, simplicity and low fixed monthly costs may be more important than negotiating a sophisticated enterprise card-pricing structure.

Larger organisations processing higher volumes should compare the total cost against actual transactions.

What Should GP Practices Compare?

What Information Should a GP Practice Provide When Comparing Providers?

A useful provider brief may include:

• practice or partnership name;
• legal entity;
• number of surgery locations;
• expected monthly private-payment turnover;
• average transaction value;
• maximum transaction value;
• number of card transactions;
• number of terminals required;
• whether payment links are needed;
• whether telephone payments are required;
• types of permitted private services provided;
• whether chargeable travel-health services are offered;
• whether third parties are invoiced;
• accounting/reporting requirements;
• current payment provider;
• current contract position; and
• the main reason for reviewing payments.

Merchant Advice Service View

NHS GP practices have a different payment requirement from private medical clinics.

The primary purpose of an NHS surgery is not to build a large private card-processing operation.

The problem is usually much more specific:

the practice performs a permitted piece of non-NHS work and needs a simple, traceable and efficient way to get paid for it.

For some practices, a card terminal may be enough.

For others, payment links could improve the process considerably because a patient can pay for a report or certificate without visiting reception or giving card details over the telephone.

Practices providing private travel-health services may need both face-to-face and remote payment options.

The starting point should therefore be:

what can legitimately be charged for + who pays + when payment is due + how the payment is collected + how private income is reconciled.

How Merchant Advice Service Helps GP Practices

Merchant Advice Service is an independent UK payments information, comparison and provider-matching service.

We can help practices compare payment arrangements based on the actual way they collect permitted private fees.

This can include:

• card machines;
• merchant accounts;
• payment links;
• virtual terminals;
• MOTO payments;
• multi-site requirements;
• settlement;
• merchant-account pricing;
• reporting requirements;
• switching an existing provider; and
• more complex primary-care payment requirements.

Merchant Advice Service does not determine whether an NHS GP practice is permitted to charge for a particular service. The practice should establish that separately using current NHS contractual, BMA, legal and professional guidance.

Final merchant-account underwriting, acceptance, pricing and commercial terms remain with the relevant payment provider.

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Sources and Reference Organisations

• British Medical Association – what services GP practices can and cannot charge for
• British Medical Association – fees and non-NHS work
• British Medical Association – insurance reports and certificates
• British Medical Association – why doctors charge for some non-NHS work
• British Medical Association – travel vaccinations and charging rules
• NHS – free and chargeable travel vaccinations
• NHS England – current GP contract information

Editorial disclosure: NHS and BMA sources are referenced to explain the distinction between NHS-funded and potentially chargeable work. Merchant Advice Service does not determine whether an individual GP service is legally or contractually chargeable. Practices should verify the current position before applying a private fee.

This guide provides general payment-processing information and does not constitute medical, NHS contractual, legal, tax, VAT or regulatory advice.