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HMRC internal manual

VAT Health

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HM Revenue & Customs
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Doctors: Table 3 Liability of services provided by Doctors

(referred to in paragraph VATHLT2050)

Guidance on the liability of the key services provided by doctors may be found at section 4 of Notice 701/57 Health Professionals and Pharmaceutical Products. However, the following table provides additional guidance on other supplies which may be made:

Services VAT liability pre 1 May 2007 VAT liability post 1 May 2007
     
Abortion - confirmatory certificate Exempt Exempt
Access to medical records - seePN 701/57 para 4.1    
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  

Exempt Exempt
Exempt Exempt |  

Exempt Exempt
Exempt
SR | | 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. | Exempt | Exempt/SR | | Benefits Agency (Department for Work and Pensions) fees - examination and report - including attendance allowance exams/reports | Exempt | SR | | 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. | Exempt | SR | | Blood tests - purpose of tests:

  • Diagnostic
  • Paternity Exempt
    SR Exempt
SR      
  Blue/orange badge scheme - examination and/or report - periodic assessments required for car-parking badges for disabled and priority housing schemes. Exempt SR
  Certificates/reports - see also PN 701/57 para 4.2    
  • 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  Exempt

Exempt Exempt
Exempt
Exempt |  SR

SR
Exempt
SR
Exempt | | Cervical smear test | Exempt | Exempt | | Character reference - Job, shotgun licence, etc | SR | SR | | Children in care - initial and subsequent examinations for ‘at risk’ children. | Exempt | Exempt | | Childminder - Ofsted health declaration form - confirmation of medical fitness to be a childminder | Exempt | SR | | Clinical trials - see VATHLT2060 above | Ex/SR | Ex/SR | | Coroner’s work - post mortem/special examinations and report. But see also statutory services in PN 701/57 para 4.13 | Exempt | SR | | Cosmetic services - see PN 701/57 para 4.4 |   |   | | Court exemption - from attending as a witness on medical grounds. Medical and/or report | Exempt | SR | | 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  

Exempt
Exempt

 

Exempt
SR |  

SR
SR

 

SR
SR | | Diagnostic tests | Exempt | Exempt | | Disability Living Allowance (DLA) - factual report and completion of DS1500 form (for benefit purposes) | Exempt | SR | | Domiciliary consultations

  • Visits (including abortive ones) - to treat patients who are unable to make it to surgery
  • Completion of form BD8 - for benefit purposes  

Exempt
Exempt |  

Exempt
SR | | 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 signature  

ExemptExempt

SR  

SR

Exempt

SR  
  Drug company reports
  • Post market surveillance form
  • Medical research questionnaire  

SR
SR |  

SR
SR | | Education services - including lectures/presentations/CPD - seePN 701/57 para 4.5 |   |   | | Employment medicals - see PN 701/57 para 4.11 re occupational health. |   |   | | Certificate of incapacity to do a particular activity | Exempt | Exempt | | Family Planning - see PN 701/57 para 4.6. Includes:

  • Associated pathological and radiological work
  • Clinical, family planning sessions for patients or instructing other doctors in family planning  

Exempt
Exempt |  

Exempt
Exempt | | Fire Service

  • Examination and report New candidate
  • Examination and report Officer seeking promotion
  • Examination and report Pension approval
  • Examination by ophthalmologist  

Exempt
Exempt
Exempt
Exempt |  

SR
SR
SR
SR | | Forensic physicians - see PN 701/57. para 4.7

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 Exempt SR
  Health & Safety Executive - pathology and X-ray examinations - concerned with preventing injury by detecting early signs of diseases with long gestation periods. Exempt Exempt
  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 provided. Arrangements vary from one PCT to another - some GPs are engaged on an employed basis (OS); others on a self- employed basis (EX). 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 self-employed (exempt) basis  

Outside the scope/Ex

 

Outside the scope

Outside the scope/Ex  

Outside the scope/Ex

 

Outside the scope

Outside the scope/Ex      
  Infection - Freedom from Infection certificate - to enable a person to attend school/work etc Exempt SR
  Insurance services - see PN 701/57 para 4.8    
  Legal aid regulations (fees under). Includes:    
  • 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/SR
Ex
Ex/SR
SR
SR |  

SR
SR
SR
SR
SR | | Local Authority visiting medical officer - to establishments maintained by local authorities | Exempt | Exempt | | 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  

 

Exempt
Exempt
Exempt |  

 

Exempt Exempt Exempt      
  Medical boards/tribunals - attendance by medical members at hearings for disciplinary or pension purposes SR SR
  Medical examinations and reports to confirm fitness to join registers of medical professions - for example, Nursing and Midwifery Council and General Dental Council Exempt SR
  Medical examinations - see PN701/57 section 4 re 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  

 

Exempt

Exempt
Exempt |  

 

Exempt

SR
SR | | Medico-legal work - see PN 701/57 para 4.9 |   |   | | Mental Health tribunals - see PN 701/57 para 4.10 |   |   | | Minor surgery for non NHS patients. Fee can be charged for procedure excluding cost of drugs and dressings | Exempt | Exempt | | National Blood Service | Exempt | Exempt | | 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 - see PN 701/57 para 4.9 |  
     
     
    Exempt |  
     
     
    Exempt | | NHS complaints and disciplinary procedures (services for) | SR/Exempt | SR | | Occupational Health - see PN 701/57 para 4.11 |   |   | | Overseas travel

  • Private prescription for travel abroad
  • Report for patients for self-referral overseas - for patients who have complex medical problems which might necessitate seeking medical treatment whilst abroad  

Exempt

Exempt  

Exempt

Exempt      
  Pacemaker removal - prior to disposal of body Exempt Exempt
  Passport countersignature SR SR
  Pilots Application for licence, fitness to fly, etc Exempt SR
  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.  

Exempt

Exempt
Exempt
Outside the scope |  

Exempt

SR
SR
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.  

 

Exempt

 Exempt  

 

SR

SR | | Pre-employment medicals/reports | Exempt | SR | | Primary care trust sessions England and Wales | Exempt | Exempt | | Prison locum work - to provide medical care | Exempt | Exempt | | Private prescription | Exempt | Exempt | | Rehabilitation services - see PN 701/57 para 4.12 |   |   | | Probation service - reports for the purpose of the courts, whether or not requested | Ex/SR | SR | | Road accident emergency treatment | Exempt | Exempt | | Sporting events/pop concerts - attendance by doctors to treat attendees as necessary - usually where number attendees exceed a specified limit. | Exempt | Exempt | | Statutory services - see PN 701/57 para 4.13 |   |   | | Vaccination and immunisation for travel abroad
International certificate of vaccination | Exempt
 
Exempt | Exempt
 
SR | | Witness testimony and allowances - see PN 701/57 para 4.14 |   |   | | 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 |  
     
    Exempt
     
     Exempt |  
     
    SR
     
     SR |