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HMRC internal manual

VAT Health

Wholly performed or directly supervised: Legal note (2): “direct supervision”

Where a registered person does not perform the service personally, but directly supervises an unregistered person, exemption may also apply. For exemption to apply, the supervisor is not required to be physically present when the services of the unregistered person are supplied. Supervision could be carried out at a distance. The services of unregistered staff are exempt provided that:

  • there is an appropriate measure of supervision by a registered health professional; and
  • the services performed amount to medical care as defined by the purpose test.