VAT Liabilities - Liability of services provided by Doctors. Changes
introduced from 1.5.07 following the D’Ambrumenil ECJ ruling
.
Full details of the liability of the key services provided by doctors can be found
at section 3 of VAT Notice 701/57 Health Professionals (January 2007).
All services whose primary purpose is the protection, maintenance or
restoration of the health of a person are exempt VAT.
As from 1.5.07, services which enable a third party to make a decision (for
example whether to award a benefit, or compensation, or a pension), are
subject to the standard rate of vat.
The following table provides detailed guidance: Important changes from
exempt to standard rate or lower rate are shown as coloured.
Services
VAT liability pre
1 May 2007
VAT liability post
1 May 2007
Abortion - confirmatory certificate
Exempt
Exempt
Access to medical records – (statutory
fee - “subject access request” under
Outside Scope
Data Protection Act 1998)
Outside Scope
Adoption and fostering health
assessment forms



Form IHA - health care plan for Exempt
children
Exempt
Forms M/B - obstetric neonatal
reports
Exempt
Forms C, D, YP or AME - full
medical assessment of child
Form AH/AH2 - health
Exempt
assessment, prospective carer
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.
Benefits Agency (Department for
Work and Pensions) fees examination and report - including
Exempt
Exempt
Exempt
SR
Exempt
Exempt/SR
Exempt
SR
attendance allowance exams/reports
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
Exempt
SR
Exempt
SR
Exempt
SR
Exempt
Exempt
SR
SR
Exempt
Exempt
Exempt
SR
Exempt
Exempt
Cervical smear test
Character reference - Job, shotgun
licence, etc
Exempt
Exempt
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 – Exempt if it involves
patient care (e.g. monitoring a patient
for adverse reactions). If any
monitoring is for purely analytical
purposes or there is no patient contact,
service is SR.
Ex/SR
Ex/SR
Blood tests - purpose of tests:


Diagnostic
Paternity
Blue/orange badge scheme examination and/or report - periodic
assessments required for car-parking
badges for disabled and priority
housing schemes.
Certificates/reports - see also PN
701/57





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
Coroner’s work - post mortem/special
examinations and report. But statutory
services are Outside Scope – see
section below
“Statutory Services”
Cosmetic services –
 If part of health care treatment
programme
 If purely for cosmetic reasons
Exempt
SR
Outside Scope
Outside Scope
Exempt
Exempt
SR
SR
Court exemption - from attending as a Exempt
witness on medical grounds. Medical
and/or report
SR
Court of Protection



Certificate CP3 With/without
examination
Exempt
SR
Serving notice Form CP7
Exempt
SR
Exempt
SR
SR
SR
Exempt
Exempt
Power of Attorney including court of
protection work


Examination and certificate
Witnessing power of attorney
Diagnostic tests
Disability Living Allowance (DLA) – Exempt
factual report and completion of
DS1500 form (for benefit purposes)
SR
Domiciliary consultations


Visits (including abortive ones)
- to treat patients who are unable Exempt
to make it to surgery
Completion of form BD8 - for Exempt
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
Seat belt exemption – only
completed where strong clinical
reason (e.g. pregnancy)
Exempt
SR
Exempt

SR

Driving licence countersignature SR
Drug company reports


Post market surveillance form
Medical research questionnaire
SR
SR
Education services - including
lectures/presentations/CPD –
 Lectures & Medical Training
provided by a doctor acting as Exempt
sole practitioner or as a partner
(exempt as education - private
tuition)
 Health Promotion Presentations Exempt
 Presentations to non-medical
SR
audiences
Employment medicals - occupational
health.
 Pre-employment medicals (to
enable employer to decide on
recruitment)
Post-employment medicals e.g.
 Assess fitness to undertake tasks
 Determine ill-health retirement
 Determine fitness to join
pension scheme
In-Service Health Screening
 Medical examination &
report (e.g. to advise on how
their job affects their health)
 Medical report for poor
attendance or poor job
performance
 Immunisation at work
 Risk Assessments including
advice on protective
clothing and improvements
to ergonomic layout
 Training and Advice on
Health issues to employees
SR
SR
Exempt
Exempt
SR
Exempt
SR
Exempt
Exempt
Exempt
Exempt
Exempt
SR
Exempt
Exempt
Exempt
Exempt
Exempt
Exempt
Exempt
SR
Exempt
Exempt
Employment Medicals - Certificate of
incapacity to do a particular activity
Exempt
Exempt
Family Planning – (e.g. counselling,
contraception and sterilisation (and
reversals) - Includes: Associated
pathological and radiological work
Exempt
Exempt
Exempt
Exempt
Exempt
Exempt
SR
SR
Exempt
SR
Exempt
SR
Exempt
Exempt
Exempt
SR
Gender recognition work - to enable Exempt
Department of Constitutional Affairs to
issue documents that person’s gender
has changed
SR

Clinical, family planning
sessions for patients or
instructing other doctors in
family planning
Fire Service




Examination and report New
candidate
Examination and report Officer
seeking promotion
Examination and report Pension
approval
Examination by ophthalmologist
Forensic physicians – (as provided by
a GP on a fee basis)


To attend to the medical needs
of victim or offender (even if
evidence is collected as part of
the process)
Later statement or report for
which separate charge is made
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.
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
Outside the scope/Ex Outside the scope/Ex
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 (Ex);
others on a self- employed (OS). Each Outside the scope
Outside the scope
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 Outside the scope/Ex Outside the scope/Ex
depend on whether the post is held on
an employed (outside the scope) or selfemployed (exempt) basis
Infection - Freedom from Infection
certificate - to enable a person to attend Exempt
school/work etc
Insurance services –
 Medical Reports for insurance
company to decide on whether
to accept an application for
insurance, or set special terms,
or establish level of premium
 Medical Reports following
claim on insurance policy
 Services in connection with
administration of policies or
claims handling
 Health Screening under terms of
insurance policy, private
medical insurance policy or
income protection insurance
Exempt (medical
exemption)
SR
Exempt (medical
exemption)
Exempt (Insurance
exemption –
following Tribunal
decision in
“Morganash Ltd”)
Exempt (Insurance
Exemption)
Exempt (insurance
exemption)
Exempt (insurance
exemption)
Exempt (medical)
Exempt (medical)
Ex/SR
SR
Exempt
SR
Ex/SR
SR
SR
SR
SR
SR
Exempt
Exempt
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)
Local Authority visiting medical
officer – to establishments maintained
by local authorities
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
Exempt
Exempt
Medical boards/tribunals - attendance
by medical members at hearings for
SR
disciplinary or pension purposes
Medical examinations and reports to Exempt
confirm fitness to join registers of
medical professions – for example,
Nursing and Midwifery Council and
General Dental Council
SR
SR
Medical examinations – see also
occupational health, insurance
services, certificates and reports.
Also, medicals for:



Seafarers - to ensure someone
Exempt
working off-shore does not go
to sea with a medical condition
which is likely to deteriorate
Compensation for ex-miners
Exempt
with vibration white finger
Criminal Injuries Compensation Exempt
Authority
Exempt
SR
SR
Medico-legal work – All medicals,
reports and expert testimony for the
judicial system, even if it concerns the
well-being of an individual
Exempt/SR
SR
Mental Health tribunals – To assess
whether a person should be detained
under the Mental Health Act –
considered to be part of medical
treatment of the person
Exempt
Exempt
Exempt
Exempt
Minor surgery for non NHS patients.
Fee can be charged for procedure
excluding cost of drugs and dressings
Exempt
Exempt
Exempt
Exempt
Exempt/SR
SR
NHS complaints and disciplinary
procedures (services for)
SR/Exempt
SR
NHS Script Fees & NHS Dispensing
Occupational Health –
Zero Rate
Zero Rate
Exempt
SR
National Blood Service
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
Employment medicals - occupational
health.

Pre-employment medicals (to
enable employer to decide on
recruitment)
Exempt
Exempt
Post-employment medicals e.g.
 Assess fitness to undertake tasks Exempt
 Determine ill-health retirement
Exempt
 Determine fitness to join
pension scheme
Exempt
Sick Notes
In-Service Health Screening
Exempt
 Medical examination &
report (e.g. to advise on how
their job affects their health)
Exempt

Medical report for poor
attendance or poor job
performance
Exempt

Immunisation at work

Risk Assessments including
Exempt
advice on protective
Exempt
Exempt
SR
Exempt
Exempt
Exempt
Exempt
SR

clothing and improvements
to ergonomic layout
Training and Advice on
Health issues to employees
Exempt
Exempt
Exempt
Exempt
SR
SR
Exempt
Exempt
Overseas travel



Private prescription for travel
abroad
Private dispensing for travel
Exempt
Report for patients for selfreferral overseas - for patients
who have complex medical
problems which might
necessitate seeking medical
treatment whilst abroad
Pacemaker removal - prior to disposal Exempt
of body
Passport countersignature
SR
Pilots Application for licence, fitness Exempt
to fly, etc
SR
SR
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
SR
Exempt
SR
Outside the scope
Outside the scope
Exempt
SR
Exempt
SR
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.
Cremation Certificate
Exempt
Exempt
Pre-employment medicals/reports
Exempt
SR
Primary care trust sessions England
and Wales
Prison locum work – to provide
medical care
Exempt
Exempt
Exempt
Exempt
Private prescription fee
Exempt
Exempt
Private dispensing
SR
SR
Private contraceptives
Lower Rate
Lower Rate
Private Vaccinations
Rehabilitation services –
 To improve the physical and
psychological health of the
individual
 Reports to determine what is
required to assist with
rehabilitation and recovery
 Reports for lawyers to
determine costs of disability for
claim to compensation
Exempt
Exempt
Exempt
Exempt
Exempt
Exempt
Exempt
SR
Probation service - reports for the
purpose of the courts, whether or not
requested
Ex/SR
SR
Road accident emergency treatment
Exempt
Exempt
Shotgun Certificates
Exempt
SR
Exempt
Sick Notes (Employment)
Sporting events/pop concerts Exempt
attendance by doctors to treat attendees
as necessary - usually where number
attendees exceed a specified limit.
Statutory services –
 Section 22 Births & Deaths
Registration Act - Issue of death Outside Scope
certificate
 Section 11 Public Health
(Control of Disease) Act 1984 – Outside Scope
notifiable disease or food
poisoning
 Section 19 Coroners Act 1998 –
Outside Scope
to conduct post-mortem
 Supreme Court Act 1981 – to
Exempt
Exempt
Outside Scope
Outside Scope
Outside Scope

give specialist evidence
Outside Scope
Blood Test (Evidence of
Exempt
paternity) Regulations –
although fees are set by statute,
the service is not statutory
Outside Scope
SR
Stop Smoking supplies (BN57)
SR
Lower Rate
________________________________ _________________ __________________
Exempt
Exempt
Vaccination and immunisation for
travel abroad
International certificate of
vaccination
Exempt
SR
Witness testimony and allowances
Exempt/SR
SR
Exempt
SR
Exempt
SR
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
John Barnes
Dispensing VAT Advice Ltd.
07775 667726
[email protected]