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HMRC internal manual

VAT Health

Doctors: Liability to VAT of out of hours cover

Where this service is provided by registered doctors or nurses who provide medical advice, then exemption will be applicable under items 1(a) or (d). If the telephones are manned by unregistered staff giving medical advice who are directly supervised by doctors or nurses, then in principle, the supply could be exempt by virtue of Legal Note 2. However, it is unlikely that such supplies would meet the conditions for direct supervision. [See paragraph VATHLT2600]. If no medical advice is given and the service is just one of call-logging or message-taking then whether the actual supply is performed by a registered health professional or an unregistered receptionist, exemption will not apply.

Item 5 of Group 7 to Schedule 9 is intended to exempt the organisation of providing deputy services and will still have relevance where GP practices have contracted back ‘out of hours’ work from PCTs. In these cases, exemption can apply to a range of accompanying administrative and support services, including;

  • administration of the scheme
  • running costs eg telephone and stationery costs;
  • monitoring telephone calls/telephone answering service; and
  • arranging transport.

However, these ‘back-up’ services will only qualify for exemption where the following two conditions are met:

  1. The back-up services are provided by the same body who makes the out-of hours service available; and
  2. The back-up services must be integral to the provision of a supply of medical care qualifying for exemption as being provided by a registered health professional.

Where the ‘out of hours’ services have been contracted out by PCTs to registered health professionals who are not doctors (for example, nurses), then exemption for ‘back-up’ services may still be available under Card Protection Plan principles (VATSC- Supply and Consideration refers).

Where the out of hours services are provided by non-registered health professionals or amount to no more than a telephone answering service, any ‘back-up’ services will also be taxable at the standard rate.