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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 Exempt Exempt
Forms M/B - obstetric neonatal reports Exempt Exempt
Forms C, D, YP or AME - full medical assessment of child Exempt Exempt
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 - see PN 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
Medical superintendent of psychiatric hospital (employed basis) Outside the scope/Exempt Outside the scope/Exempt
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
MRI/CT scans - fee is for the doctor’s interpretation of the scans, not for the scans themselves Exempt SR
Attendance at consultation Exempt SR
Making arrangements to attend court Exempt/SR SR
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
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
Compensation for ex-miners with vibration white finger Exempt SR
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
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
Written report Exempt SR
Police station Attendance at patient’s request (to document injuries for future medical claims) Exempt SR
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
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
Report on a pro-forma - no examination Exempt SR