The NHS isn't exactly free, as we have to pay for all sorts of things from prescription charges to accessing our medical records. Now some surgeries are cashing in with 0845 numbers, despite being banned from doing so!

Britain has a lot to be proud of with the NHS – we only need to look at our neighbours across the Atlantic to see how brutal it can be for those who can't afford health insurance. Despite its problems, our NHS is admired the world over, and free health care for all is an amazing accomplishment.


Is the NHS really free?
While the NHS aims to provide most health care to people free of charge, there are exceptions. For example, prescription charges in England have existed since 1951 and a prescription currently costs £7.65, rising to £7.85 on 1st April (prescriptions cost nothing if you live in Scotland, Wales or N. Ireland).

Make sure that you are not inadvertently paying for your prescriptions if you don't have to. You are exempt from charges in the following circumstances:

  • Income-related employment and support allowance, income support, income-based jobseeker's allowance or pension credit guarantee credit
  • If you are have a specific illness such as cancer (see Disability Rights UK for a full list of exempt illnesses)
  • If you are pregnant or for one year after giving birth (you need to prove this with a valid maternity certificate).
  • Children are exempt until they are 16 (or 19 if they are in full time education.)

Even if you don't qualify for free prescriptions there is still a way to save money. If you know you will have to pay for a lot of prescriptions look into getting a Prescription Payment Certificate. It acts as a kind of 'season ticket' and you pay £29.10 for three months or £104 for 12 months.

Things you must pay for
The NHS does not actually employ GPs but simply has a contract with them to provide general medical services for patients. When GPs are asked to perform 'additional services' they are entitled to ask a reasonable charge for providing them.

For these services, the doctor has discretion over how much they will charge, and while the British Medical Association has a suggested list of fees, your doctor is not obliged to stick with them.

Below are the details of a few things a GP can charge for.

Accessing your medical records
People are often surprised that they have to pay not only for copies of their own medical records, but also simply for viewing them. It pays to know the exact situation so you are not overcharged.

According to the NHS website, there should be no charge if:

  • your records have been updated in the last 40 days.
  • your records are purely in 'paper form' (i.e. do not include things like x-rays or films)
  • you do not require a physical copy – just wish to view them

However, if these don't apply and your records are held partially on computer, partially on a physical paper file and are partly made up of x-rays and films the maximum charge could be up to £50.

Looking at a random sample of surgery charges in the UK shows that some surgeries are charging £75 for your full medical records, so it may be possible to challenge these charges if they are excessive.

Letters requested by, or on behalf of, the patient
Doctors will generally charge you around £10 for a letter requested by yourself, such as a letter for your gym to say you are fit to exercise (some gyms insist on this).

One thing they should not charge for is a 'sick note'. Officially called a Statement for Fitness to Work, these are required by many employers if you have been off work for over seven days. There should never be a charge for this note. However if you have been off sick for less than seven days and still require a note then a doctor is likely to charge you around £10-£15 for this.

Yes, they are even after you when you are dead!
Before cremation can happen two certificates need to be signed, one by your GP and one by another doctor. This is so the cause of death is definitely known and properly recorded before you are disposed of! The doctor usually charges the funeral director, but this charge is then passed to the family. The suggested fee is £76, but this is negotiable.

It is important to note that there is not a fee for a death certificate – these are free of charge.

Passport Application
A doctor will charge £25-£30 to countersign your passport application.

Try asking another professional, like a teacher or bank manager (see the Home Office website for a list of suitable counter-signatories) and they might just do it for free!

Less transparent charges
While you may not like some of the charges above, your surgery might be guilty of other charges that aren't so transparent.

Some GP surgeries are still using 0844 telephone numbers, a practice banned by the Department of Health. Many claim that they have been tied into long-term 0844 contracts, but this is no excuse. As campaign group Fair Telecoms points out, even if tied into a long-term telephone service contract it is possible to retain the contract but migrate from using the 0844 number to using the equivalent, but cheaper, 0344 number.

If your surgery is still using one of these numbers it is time to take action. Complain to your surgery and to your local MP. Then visit a website like Saynoto0870 (it also includes 0844 numbers) which may list an alternative geographical number. Check out How to call 0845 and 0870 numbers for free! for more.