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HMRC internal manual

VAT Health

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 Exempt  
  Exempt  
     
Adoption and fostering health assessment forms -Forms M/B - obstetric neonatal reports Exempt Exempt
Adoption and fostering -Forms C, D, YP or AME - full medical assessment of child    
  Exempt Exempt  
  Adoption and fostering -Form AH/AH2 - health assessment, prospective carer 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 Exempt  
  Exempt    
  Blood tests-purpose of tests:Paternity SR 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 minor injury - report/exam  Exempt  
   SR    

 
  | | Certificates/reports - see also PN 701/57 para 4.2:Community service certificate for offenders who fail to attend

  Exempt SR
  Certificates/reports - see also PN 701/57 para 4.2:Cremation certificates  
  Exempt Exempt
  Certificates/reports - see also PN 701/57 para 4.2: Freedom from infection certificate  

  | Exempt | SR | | Certificates/reports - see also PN 701/57 para 4.2: Validation of Private Medical Insurance claim form | Exempt | 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 | Exempt/SR | Exempt/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 | Exempt
  | SR
 

   
  Court of Protection -Serving notice Form CP7
  Exempt SR
  Court of Protection -Power of Attorney including court of protection work  
  Exempt SR
  Court of Protection- Examination and certificate  
  Exempt SR  
  Court of Protection -Witnessing power of attorney 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 Exempt  
  Exempt    
       
  Domiciliary consultations-Completion of form BD8 - for benefit purposes 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 Exempt  
  SR
       
  Driving-Seat belt exemption - only completed where strong clinical reason (e.g. pregnancy) Exempt Exempt
  Driving-Driving licence signature SR SR
  Drug company reports-Post market surveillance form SR  
  SR    
       
  Drug company reports- Medical research questionnaire 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 Exempt  
  Exempt    
       
  Family Planning - see PN 701/57 para 4.6. Includes:    
Clinical, family planning sessions for patients or instructing other doctors in family planning Exempt Exempt
  Fire Service-Examination and report New candidate Exempt
  SR  
   
  Fire Service -Examination and report Officer seeking promotion
  Exempt SR
  Fire Service-Examination and report Pension approval  
  Exempt SR  
  Fire Service -Examination by ophthalmologist Exempt 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.  

Outside the scope/Exempt

   

Outside the scope/Exempt

   
  Hospital appointments

Medical superintendent of psychiatric hospital (employed basis)

   

Outside the scope/Exempt

 

   

Outside the scope/Exempt

 

   
  Hospital appointments
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/Exempt

   

Outside the scope/Exempt

       
  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 Exempt/SR SR
  Legal aid regulations (fees under). Includes  

MRI/CT scans - fee is for the doctor’s interpretation of the scans, not for the scans themselves

  Exempt SR
  Legal aid regulations (fees under). Includes:  
Attendance at consultation Exempt SR
  Legal aid regulations (fees under). Includes:  
Making arrangements to attend court Exempt/SR SR
  Legal aid regulations (fees under).  
Attendance at court (expert witness) 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                                                      

   

Exempt
  |  

Exempt  
  Local Authority work -Consultant or specialist work:

Dental anaesthetic session

  Exempt Exempt  
  Local Authority work Psychiatric examinations - required to enable person to be treated under Mental Health Act 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 PN 701/57 section 4 re occupational health, insurance services, certificates and reports. Also, medicals for:    
Seafarers-to ensure someone working offshore does not go to sea with a medical condition which is likely to detoriorate Exempt Exempt  
       
  Medical examinations - see PN701/57 section 4 re occupational health, insurance services, certificates and reports. Also, medicals for:    
Compensation for ex-miners with vibration white finger  

 

Exempt  

 

SR  
  Medical examinations - see PN701/57 section 4 re occupational health, insurance services, certificates and reports. Also, medicals for
Criminal Injuries Compensation Authority Exempt 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. |  
 
 
Exempt |  
 
 
Exempt | | National Society for Prevention of Cruelty to Children

Attendance at magistrate’s/crown court - see PN 701/57 para 4.9      
  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 Exempt           Exempt
  Overseas travel    
Report for patients for self-referral overseas - for patients who have complex medical problems which might necessitate seeking medical treatment whilst abroad  
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

   
Exempt  

Exempt

 
  | | Police work

Written report  
Exempt  
SR  
  Police work

Police station Attendance at patient’s request (to document injuries for future medical claims)

  Exempt     SR
  Police work  
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  

Exempt

   
SR  
  Post mortem examinations and reports
Anaesthetic deaths - where a doctor is instructed to interview a surgeon, anaesthetist or other person on connection with an anaesthetic death.  
Exempt  

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 | Exempt/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
 
  | | 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 |  
 
Exempt
 
  |  
 
SR
 
  | | Work in surgery (not elsewhere covered)

Report on a pro-forma - no examination Exempt SR