Navigating UK healthcare
NHS general practice covers NHS clinical work. A defined list of non-NHS services sits outside that contract, and GP practices are allowed to charge patients directly. Here is what those services are, why they are paid for, and how to approach them.
Dr Seth Rankin
MBChB MRCGP. Founder of LoveMyLife. Former NHS Commissioner and Managing Partner of Wandsworth Medical Centre.
23 April 2026
9 min read
Registering with a National Health Service (NHS) general practice gives you a broad package of clinical care at no cost at the point of use. Not everything that a general practitioner (GP) can do, though, is inside the NHS contract. A well-defined list of medical reports, certificates, occupational and regulatory medicals, and some travel health services sits outside NHS commissioning. GP practices can offer these to their registered patients as private work, and charge a fee for doing so.
The fee pays for the clinician's time, the administrative work of writing and signing the report, and the professional indemnity associated with non-NHS work. It is not unusual. It is not the NHS being withheld. It does not change your free access to NHS clinical care.
This article sets out the services most commonly charged for by NHS practices, why they are outside the NHS contract, and how to approach them when you need one. Sources for the fee categories and external organisations are at the end.
NHS general practice is funded through the General Medical Services (GMS) or Personal Medical Services (PMS) contract, which defines the clinical work that the NHS pays a practice to do for its registered patients. Anything outside that definition is non-NHS work. The British Medical Association (BMA) publishes guidance on what falls where, and most practices follow it.
Three principles explain most of what falls outside the NHS contract.
Work done for a third party, rather than for the patient's clinical care, is not NHS work. An insurance company, an employer, a regulator, a court, or a visa authority asking a GP for a report is commissioning that report from the GP privately.
Work that requires specific additional training or regulatory certification sits outside the standard NHS GP role. Seafarer ENG1 medicals, for example, require a doctor approved by the Maritime and Coastguard Agency (MCA) rather than any GP.
Travel health services that are not NHS-commissioned are paid for by the patient. Some travel vaccines are NHS-funded; many are not.
In each case, the same GP who looks after you on the NHS can do the work for you privately, at a fee set by the practice. The two do not interfere with one another.
These are medicals required by law, by a regulator, or by an employer to confirm that you are fit to perform a particular role.
Driver and Vehicle Licensing Agency (DVLA) Group 2 driver medicals. Drivers of Heavy Goods Vehicles (HGVs), Public Service Vehicles (PSVs), buses, coaches, and certain large vehicles need a DVLA D4 medical at defined points. Many NHS GPs offer D4 medicals privately.
Taxi and private hire medicals. Transport for London (TfL) uses the 204 form for licensed taxi (black cab) and private-hire vehicle (PHV) drivers. Other local authorities have their own equivalents.
Pre-employment medicals for new employees, particularly in safety-sensitive or healthcare roles.
Safety-critical worker medicals, for example railway workers, scaffolders, and workers at height, described in Health and Safety Executive (HSE) guidance.
Night-worker health assessments required under the Working Time Regulations.
The fee depends on the complexity of the medical and the practice. Ask the practice for their fee schedule before booking.
These confirm that you are fit for a particular activity, usually one where a medical event would be a problem for you or for others.
Sports medicals for leagues, academies, or recreational clubs that require one.
Boxing medicals under the British Boxing Board of Control rules for amateur and professional boxing.
Marathon and endurance event medicals for longer races and ultra-events.
SCUBA diving medicals for recreational diving under UK Diving Medical Committee guidance. Commercial HSE-approved diving medicals require a specifically accredited doctor and are a separate process.
Motorsport medicals for licensed racing and rallying, typically under Motorsport UK rules.
Firearms and shotgun certificate medical reports requested by the police as part of the firearms licensing process.
Fitness-to-fly letters where an airline has asked for medical clearance, usually for a specific condition, pregnancy, or recent surgery.
Fitness-to-dive letters for cruises, expeditions, or higher-altitude travel.
A regulated process sits around reports written for insurers, lawyers, or courts.
Private Medical Attendant (PMA) reports written for life, income protection, critical illness, or private medical insurance (PMI) underwriting.
Subject Access Reports (SAR), sometimes known as "targeted medical reports", requested by insurers and governed by the Access to Medical Reports Act 1988.
Solicitor reports for civil or family matters where medical information is relevant.
Personal injury reports for claims arising from accidents.
Medicolegal reports for court proceedings.
These reports are paid for by whoever commissions them, which is sometimes the insurer, sometimes the patient, and sometimes the patient's solicitor, depending on who asked for it.
A long list of short reports and letters sits outside the NHS contract.
Adoption and fostering medicals required by agencies under CoramBAAF guidance.
School and university medical reports beyond the standard NHS school record.
Holiday cancellation letters confirming why a trip had to be cancelled.
Cruise fitness letters beyond a standard fit-to-fly.
Passport counter-signing for applicants who need a professional countersignatory.
Lasting Power of Attorney (LPA) capacity assessments and Court of Protection COP3 forms for capacity decisions.
Visa medical reports for countries that require a General Medical Council (GMC) registered doctor to complete a visa medical form.
Private sick notes or employer letters beyond the statutory NHS fit note.
Different practices offer different services. Smaller practices may decline report work they do not have capacity for. Larger practices and some private GP clinics carry a broader list.
Travel health sits half inside the NHS and half outside.
NHS-funded travel vaccines include hepatitis A, typhoid, combined diphtheria-tetanus-polio, and, under specific circumstances, cholera. These can be given free through your NHS practice if the practice offers a travel clinic.
Private travel vaccines and medications include yellow fever, Japanese encephalitis, rabies pre-exposure, tick-borne encephalitis, hepatitis B (for travel), meningitis ACWY (for travel), and most antimalarial tablets. Yellow fever requires vaccination at a designated yellow fever vaccination centre; many NHS practices are registered as centres, and many travel clinics are too.
The NHS publishes the funded-vaccine list and country-by-country travel health advice through the National Travel Health Network and Centre (NaTHNaC) service at travelhealthpro.org.uk.
Most practices publish a fee list on their website, on a noticeboard in the waiting room, or on request at reception. Fees for medicals and reports vary by practice and by region, but typical price ranges can be found in the BMA's guidance on private work.
If your NHS practice does not offer a service you need, you have three options.
Ask whether they can refer you to another NHS practice locally that does offer it privately.
Book the service with a dedicated provider, for example an occupational health company for pre-employment medicals or a travel clinic for travel vaccines.
Book with a private GP clinic that offers the full range.
In all three cases, the work is treated as private, is paid for at the point of service, and does not affect your NHS registration or entitlements.
LoveMyLife offers most of the services on this page directly. Our GPs provide occupational and regulatory medicals, fitness-to-perform medicals, insurance and legal reports, the full list of non-NHS travel vaccines, and a range of reports and letters. Fees are published in advance and are fixed per service. You do not need to be a regular patient at LoveMyLife to book a single medical or report.
We always encourage patients to remain fully registered with their NHS GP. Medicals and reports from us do not replace NHS care; they sit alongside it.
NHS general practice covers NHS clinical work, which is broad but not unlimited. A defined list of medicals, reports, letters, and travel health services is outside the NHS contract, and GP practices may charge patients for them directly. These are not gaps in care. They are categories of non-NHS work that the NHS has not taken on, either because they are commissioned by third parties, because they require additional certification, or because they fall outside the services the NHS chooses to fund.
When you need one, ask your practice what they offer and what the fee is. If they do not offer it, a travel clinic, an occupational health provider, or a private GP clinic will.
British Medical Association, Fees for GPs. Guidance on fees for non-NHS work by GP practices.
gov.uk, D4 medical examination report. The DVLA Group 2 driver medical form.
gov.uk, Seafarer medical certificates. ENG1 process and MCA-approved doctors.
Transport for London, Taxi and private hire fitness to practise. TfL 204 form and driver medicals.
Health and Safety Executive, hse.gov.uk. Safety-critical work medicals and guidance.
gov.uk, Night working hours. Statutory health assessment for night workers.
UK Diving Medical Committee, ukdmc.org. Recreational SCUBA diving medicals.
Motorsport UK, motorsportuk.org. Motorsport licensing and medical rules.
gov.uk, Apply for a firearm certificate. Police-led firearms licensing and medical reports.
legislation.gov.uk, Access to Medical Reports Act 1988. The legal framework for insurer reports.
gov.uk, Form COP3: assessment of capacity. Court of Protection capacity assessment.
gov.uk, Countersigning passport applications. Professional countersignatory rules.
NHS, Travel vaccinations. NHS-funded vs private travel vaccines.
NaTHNaC, travelhealthpro.org.uk. UK travel-health advice for clinicians and the public.
NaTHNaC, Yellow fever vaccination centres. Designated centres for yellow fever vaccination.
NHS, Sick notes (fit notes). The statutory NHS fit note.
CoramBAAF, coramadoption.org.uk. Adoption and fostering medical guidance.
Clinically reviewed
Dr Seth Rankin · MBChB MRCGP - Founder and Medical Director, LoveMyLife
Dr Seth Rankin qualified in medicine at Auckland School of Medicine in New Zealand in 1990 and worked as a junior doctor across New Zealand, Australia, and the UK before qualifying as a Member of the Royal College of General Practitioners (MRCGP) through the London Deanery in 2004. He was Managing Partner of Wandsworth Medical Centre from 2006 to 2016 and served as a Board Member of Wandsworth Clinical Commissioning Group for nine years. He is the founder of London Travel Clinic, London Doctors Clinic, London Medical Laboratory, and LoveMyLife.
If you need a medical, report, or travel vaccine that your NHS practice does not offer, we can help.
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