VAT Liabilities - Liability of services provided by Doctors. Changes introduced from 1.5.07 following the D Ambrumenil ECJ ruling. Full details of the liability of the key services provided by doctors can be found at section 3 of VAT Notice 701/57 Health Professionals (January 2007). All services whose primary purpose is the protection, maintenance or restoration of the health of a person are exempt VAT. As from 1.5.07, services which enable a third party to make a decision (for example whether to award a benefit, or compensation, or a pension), are subject to the standard rate of vat. The following table provides detailed guidance: Important changes from exempt to standard rate or lower rate are shown as coloured. Services VAT liability pre 1 May 2007 VAT liability post 1 May 2007 Abortion - confirmatory certificate Access to medical records (statutory fee - subject access request under Data Protection Act 1998) Adoption and fostering health assessment forms Form IHA - health care plan for children Forms M/B - obstetric neonatal reports Forms C, D, YP or AME - full medical assessment of child Form AH/AH2 - health assessment, prospective carer Attendance at airports - reason for attendance varies - for example, could be to treat large number of sick passengers or confirm that passenger who has been arrested is fit to be detained. Liability will depend on purpose. / Benefits Agency (Department for Work and Pensions) fees - examination and report - including attendance allowance exams/reports
Blind or partially sighted - examination and completion of forms BD8/BP1 - allows Local Authority to register persons as blind/partially sighted, enabling them to qualify for benefits. Blood tests - purpose of tests: Diagnostic Paternity Blue/orange badge scheme - examination and/or report - periodic assessments required for car-parking badges for disabled and priority housing schemes. Certificates/reports - see also PN 701/57 Assessment of mining injury report/exam Community service certificate for offenders who fail to attend Cremation certificates Freedom from infection certificate Validation of Private Medical Insurance claim form Cervical smear test Character reference - Job, shotgun licence, etc Children in care - initial and subsequent examinations for at risk children. Childminder - Ofsted health declaration form - confirmation of medical fitness to be a childminder Clinical trials if it involves patient care (e.g. monitoring a patient for adverse reactions). If any monitoring is for purely analytical purposes or there is no patient contact, service is. Coroner s work - post mortem/special examinations and report. But statutory services are see section below Ex/ Ex/
Statutory Services Cosmetic services If part of health care treatment programme If purely for cosmetic reasons Court exemption - from attending as a witness on medical grounds. Medical and/or report Court of Protection Certificate CP3 With/without examination Serving notice Form CP7 Power of Attorney including court of protection work Examination and certificate Witnessing power of attorney Diagnostic tests Disability Living Allowance (DLA) factual report and completion of DS1500 form (for benefit purposes) Domiciliary consultations Visits (including abortive ones) - to treat patients who are unable to make it to surgery Completion of form BD8 - for benefit purposes Driving Full medical and/or report - to determine fitness to hold standard driving/lgv/hgv licence. Includes visual field tests, blood tests, ECGs etc Seat belt exemption only completed where strong clinical reason (e.g. pregnancy) Driving licence countersignature
Drug company reports Post market surveillance form Medical research questionnaire Education services - including lectures/presentations/cpd Lectures & Medical Training provided by a doctor acting as sole practitioner or as a partner (exempt as education - private tuition) Health Promotion Presentations Presentations to non-medical audiences Employment medicals - occupational health. Pre-employment medicals (to enable employer to decide on recruitment) Post-employment medicals e.g. Assess fitness to undertake tasks Determine ill-health retirement Determine fitness to join pension scheme In-Service Health Screening Medical examination & report (e.g. to advise on how their job affects their health) Medical report for poor attendance or poor job performance Immunisation at work Risk Assessments including advice on protective clothing and improvements to ergonomic layout Training and Advice on Health issues to employees Employment Medicals - Certificate of incapacity to do a particular activity Family Planning (e.g. counselling, contraception and sterilisation (and reversals) - Includes: Associated pathological and radiological work
Clinical, family planning sessions for patients or instructing other doctors in family planning Fire Service Examination and report New candidate Examination and report Officer seeking promotion Examination and report Pension approval Examination by ophthalmologist Forensic physicians (as provided by a GP on a fee basis) To attend to the medical needs of victim or offender (even if evidence is collected as part of the process) Later statement or report for which separate charge is made Note - charges for trainees attending the same call-out will attract the same liability as that of the forensic physician, as the trainee is a registered doctor. Gender recognition work - to enable Department of Constitutional Affairs to issue documents that person s gender has changed Health & Safety Executive - pathology and X-ray examinations concerned with preventing injury by detecting early signs of diseases with long gestation periods. Hospital appointments GP work in hospitals - where local GPs admit, treat and discharge their own patients in community hospitals. Sometimes a casualty service is also Outside the scope/ex Outside the scope/ex
provided. Arrangements vary from one PCT to another some GPs are engaged on an employed basis (Ex); others on a self- employed (OS). Each case will need to be considered on the individual facts. Medical superintendent of psychiatric hospital (employed basis) Liability of other part-time hospital (health) posts held by practitioners will depend on whether the post is held on an employed (outside the scope) or selfemployed (exempt) basis Infection - Freedom from Infection certificate - to enable a person to attend school/work etc Outside the scope Outside the scope/ex Insurance services Medical Reports for insurance company to decide on whether to accept an application for insurance, or set special terms, or establish level of premium (medical exemption) Medical Reports following claim on insurance policy (medical exemption) Services in connection with administration of policies or (insurance claims handling exemption) Health Screening under terms of insurance policy, private (medical) medical insurance policy or income protection insurance Legal aid regulations (fees under). Includes: Outside the scope Outside the scope/ex (Insurance exemption following Tribunal decision in Morganash Ltd ) (Insurance ion) (insurance exemption) (medical) Examinations and/or reports MRI/CT scans - fee is for the doctor s interpretation of the scans, not for the scans themselves Attendance at consultation Making arrangements to attend court Attendance at court (expert witness) Ex/ Ex/ Local Authority visiting medical officer to establishments maintained by local authorities
Local Authority work Consultant or specialist work School ophthalmic session Dental anaesthetic session Psychiatric examinations - required to enable person to be treated under Mental Health Act Medical boards/tribunals - attendance by medical members at hearings for disciplinary or pension purposes Medical examinations and reports to confirm fitness to join registers of medical professions for example, Nursing and Midwifery Council and General Dental Council Medical examinations see also occupational health, insurance services, certificates and reports. Also, medicals for: Seafarers - to ensure someone working off-shore does not go to sea with a medical condition which is likely to deteriorate Compensation for ex-miners with vibration white finger Criminal Injuries Compensation Authority Medico-legal work All medicals, reports and expert testimony for the judicial system, even if it concerns the well-being of an individual / Mental Health tribunals To assess whether a person should be detained under the Mental Health Act considered to be part of medical treatment of the person Minor surgery for non NHS patients. Fee can be charged for procedure excluding cost of drugs and dressings National Blood Service
National Society for Prevention of Cruelty to Children Condition of child visit, examination, certificate - undertaken where vulnerable child unable to give account of medical history. Exams etc enable carer to adequately look after child and ensure ongoing health conditions treated. Attendance at magistrate's/crown court / NHS complaints and disciplinary procedures (services for) Occupational Health Employment medicals - occupational health. / Pre-employment medicals (to enable employer to decide on recruitment) Post-employment medicals e.g. Assess fitness to undertake tasks Determine ill-health retirement Determine fitness to join pension scheme In-Service Health Screening Medical examination & report (e.g. to advise on how their job affects their health) Medical report for poor attendance or poor job performance Immunisation at work Risk Assessments including advice on protective clothing and improvements to ergonomic layout Training and Advice on Health issues to employees
Overseas travel Private prescription for travel abroad Private dispensing fro travel Report for patients for selfreferral overseas - for patients who have complex medical problems which might necessitate seeking medical treatment whilst abroad Pacemaker removal - prior to disposal of body Passport countersignature Pilots Application for licence, fitness to fly, etc Police work Retainers/attendance fees for call-outs to examine body/witness/detainee/victim/ other. Also applies to non police surgeons Written report Police station Attendance at patient s request (to document injuries for future medical claims) Financial assistance provided for continuing medical education - no direct link between supply and payment. Outside the scope Outside the scope Post mortem examinations and reports Examination and report to coroner Anaesthetic deaths - where a doctor is instructed to interview a surgeon, anaesthetist or other person on connection with an anaesthetic death. Cremation Certificate Pre-employment medicals/reports
Primary care trust sessions England and Wales Prison locum work to provide medical care Private prescription Private dispensing Private contraceptives Rehabilitation services To improve the physical and psychological health of the individual Reports to determine what is required to assist with rehabilitation and recovery Reports for lawyers to determine costs of disability for claim to compensation Probation service - reports for the purpose of the courts, whether or not requested Lower Rate Ex/ Lower Rate Road accident emergency treatment Sporting events/pop concerts - attendance by doctors to treat attendees as necessary - usually where number attendees exceed a specified limit. Statutory services Section 22 Births & Deaths Registration Act - Issue of death certificate Section 11 Public Health (Control of Disease) Act 1984 notifiable disease or food poisoning Section 19 Coroners Act 1998 to conduct post-mortem Supreme Court Act 1981 to give specialist evidence Blood Test (Evidence of paternity) Regulations although fees are set by statute, the service is not statutory Stop Smoking supplies (BN57) Vaccination and immunisation for travel abroad International certificate of Lower Rate
vaccination Witness testimony and allowances / Work in surgery (not elsewhere covered) Pharmaceutical trials - certification as to suitability to take part as non-patient volunteer Report on a pro-forma - no examination John Barnes, Baker Tilly, Leeds. 0113 285 5221