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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-see PN 701/57 para 4.1    
Adoption and fostering health assessment forms    

Form IHA - health care plan for children

Forms M/B - obstetric neonatal repaorts

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-reasons 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/BD1-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 assessemtns required for car parking bages for diabled 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

Fredom from infection certificate

Validation of Private Medical Insurance claim form  

Exempt

Exempt

Exempt

Exempt

Exempt  

SR

SR

Exempt

SR

Exempt      
  Cerival 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-confrirmation 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 cerificate

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  

Exempt

Exempt

SR  

SR

Exempt

SR  
  Drug company reports

Post market surveillance form

Medical research questionnaire  

SR

SR  

SR

SR  
  Education services-including
lectures/presentations/CPD-see PN 701/57 para 4.5      
  Employement 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 patiens or instructing other doctors in family planning  

Exempt

Exempt  

Exempt

Exempt  
  Fire service

Examination and report New condicate

Examination and report Officer seeking promotion

Examination and report Pension appproval

Examination by ophthalmologist  

Exempt

Exempt

Exempt

Exempt  

SR

SR

SR

SR  
  Foresnic 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. sometinmes a casulty service is also provided. Arrangements vary from one PCT to another-soem GPs are engaged on an 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 enabkle 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 doctors interpretation of the scans, not the scans themselves

Attendance at consultation

Making arrangments 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 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

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 Cruelity 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 Exempt Exempt
  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 surgei=ons

Written report

Police station Attendance at patients request (to document injuries for future medical claims)

Financial assistance provided for continuing medical educstion-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 services-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 attndees 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

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

Report on a pro-forma-no examination  

Exempt

Exempt  

SR

SR