UT/2023/000009 - [2024] UKUT 00162 (TCC)

Goods can only fall within the c) exemption if they are “physically and economically indissociable”. (There is no dispute that the case-law provides for such exception - for example a bandage or eye-drops applied in the course of treatment. HMRC do not however seek to argue the drugs and sexual health products here fall into that exception.)

The above rule (generally) cannot be overridden by a single supply CPP/Levob analysis thereby expanding the scope of exemption c).

Because of the inherently limited nature of exemption c) (its limitation to medical consultations carried out by certified practitioners within the confines of the confidential patient/practitioner relationship), medical care under exemption c) could never (in the circumstances of this case) be the predominant part of a single composite supply so as to make that supply exempt. (Ms Hall acknowledges this proposition is fact dependent. She accepts there could be circumstances where the medical care element would predominate giving the example of a medical consultation provided online where the service of accessing the online platform was provided in addition to the medical care).

Medical care under exemption c) must be narrower than under exemption b) and things “closely-related” to b) (to avoid undermining the fact that “closely-related” words do not appear in c).