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At the heart of general practice since 1960

Warfarin prescribing not being targeted at highest risk groups

Q. Please can you

clarify the

issues of

charging for

hepatitis B


A. Hepatitis B immunisation is not routinely available free of charge.


GPs can charge patients privately for this vaccination if it is requested in connection with travel abroad.

If hepatitis B immunisation is combined with hepatitis A in a single injection, you may not charge a fee for the hepatitis A component and you are, therefore, not permitted to

charge for the hepatitis B element either.

You may refuse to provide any travel immunisations and may refer the patient to a specialist travel clinic.

Occupational health

Hepatitis B has always been a very contentious issue. Some GPs believed occupational hepatitis B could be given by the GP acting as an 'agent' for the employer. The GPC did not agree with this 'arrangement' and believed it to be contrary to the regulations, as GPs were not supposed to charge the patient or anyone else on the patient's behalf for this service.

It received a legal opinion that supported this view. Most LMCs, including Wessex, are now of the view that this is correct.

You are not obliged to provide an occupational health service as part of your NHS duties. You could be at risk of negligence if a patient did not receive appropriate accompanying advice on minimising the risk of hep B and other blood-borne viruses such as hep C or HIV. You could also be at risk if the occupational hazards were not assessed with a view to reducing the risk.

Hepatitis B immunisation should ideally be given only if shown to be necessary after a full COSSH assessment.

If the patient is at very obvious risk and has no access to an occupational health service, it could perhaps be argued that it should be part of normal NHS primary care to provide protection from a potentially very serious, or even fatal, infection.

However, a private occupational health consultation and treatment with another doctor would probably still be the most appropriate way forward to ensure a full preventive occupational health service is provided.

If a GP is qualified to provide a full occupational health service it would be acceptable if the GP offered to provide the service to a company for any or all of its employees on a private basis, rather than providing individual services for specific NHS-registered patients.

The GP would therefore be offering this private occupational health service to patients registered with any practice, which could include his or her own practice.

Global sum

If hepatitis B immunisation and advice is required for some other non-occupational reason which places the patient at risk of infection, this should be provided as normal GP services which are included within the global sum.

Immunisation may be required on this basis for:

·Babies born to mothers who are chronic carriers of hepatitis B virus or to mothers who have had acute hepatitis B during pregnancy

·Parenteral drug misusers

·Individuals who change sexual partners frequently

·Close family contacts of a case or carrier

·Families adopting children from countries with a high prevalence of hepatitis B


·Patients with chronic renal failure

·Travellers to areas of high hepatitis prevalence

·Children born outside the UK and who have received a primary dose in their country of origin and who are now domiciled in the UK should have their course of the vaccine completed under GMS.

Charging for hep B immunisations has been a very fuzzy area for many years. Hopefully this will help to clarify matters.

Dr Christine Dewbury, Wessex LMCs

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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