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The Health and Personal Social Services (General Medical Services Contracts) Regulations (Northern Ireland) 2004

Type Ni-Statutory-Rule

Publication 2004-03-29

Last updated 2023-11-06

State In force

Jurisdiction Northern Ireland

Department Government Printer for Northern Ireland

Source legislation.gov.uk

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Made: 29th March 2004

Coming into operation: 29th March 2004

The Department of Health, Social Services and Public Safety[^f00001], in exercise of the powers conferred on it by Articles 15C(1)(b)(iii), 55B(7), 57A, 57B, 57E, 57F, 106 and 107(6) of the Health and Personal Social Services (Northern Ireland) Order 1972[^f00002] and Article 8(6) of the Health and Personal Social Services (Northern Ireland) Order 1991[^f00003] and of all other powers enabling it in that behalf, in conjunction with the Department of Finance and Personnel, hereby makes the following Regulations:

PART 1 — GENERAL

Citation and commencement

1

These Regulations may be cited as the Health and Personal Social Services (General Medical Services Contracts) Regulations (Northern Ireland) 2004 and shall come into operation on 29th March 2004.

Interpretation

2

In these Regulations –

“additional services” means one or more of –cervical screening services,contraceptive services, vaccines and immunisations,childhood vaccines and immunisations,child health surveillance services,maternity medical services, andminor surgery;

“adjudicator” means the Department or a person or persons appointed by the Department under Article 8(6) of the 1991 Order or paragraph 93(5) of Schedule 5;

“appliance” means an appliance which is included in a list for the time being approved by the Department for the purposes of Article 63 of the Order;

“approved medical practice” shall be construed in accordance with section 11(4) of the Medical Act 1983[^f00004];

“Article 15B provider” means a person who is providing primary medical services in accordance with Article 15B arrangements[^f00005];

“assessment panel” means a committee or sub-committee of a Board (other than the Board which is a party to the contract in question) appointed to exercise functions under paragraph 35 of Schedule 5;

“batch issue” means a form provided by the Agency and issued by a prescriber at the same time as a repeatable prescription to enable a chemist to receive payment for the provision of repeat dispensing services, and which –is generated by a computer and not signed by a prescriber,relates to a particular repeatable prescription and contains the same dates as that prescription,is issued as one of a sequence of forms, the number of which is equal to the number of occasions on which the drugs, medicines or appliances ordered on the repeatable prescription may be provided, andspecifies a number denoting its place in the sequence referred to in paragraph (c);

“the Board” means the Regional Board

“CCT” means Certificate of Completion of Training awarded under Article 8 of the 2003 Order...

“cervical screening services” means the services described in paragraph 2(2) of Schedule 1;

“charity trustee” means one of the persons having the general control and management of the administration of a charity;

“chemist” means –a registered pharmacist,a person lawfully conducting a retail pharmacy business in accordance with section 69 of the Medicines Act 1968[^f00006], ora supplier of appliances,who is included in the pharmaceutical list under Article 63 of the Order.

“child health surveillance services” means the services described in paragraph 6(2) of Schedule 1;

“childhood vaccines and immunisations” means the services described in paragraph 5(2) of Schedule 1;

“chiropodist or podiatrist independent prescriber” means a person—who is either engaged or employed by the contractor or is a party to the contract,who is registered in Part 2 of the register maintained under Article 5 of the Health and Social Work Professions Order 2001[^f00005], andagainst whose name in that register is recorded an annotation signifying that he is qualified to order drugs, medicines and appliances as a chiropodist or podiatrist independent prescriber;

“closed”, in relation to the contractor’s list of patients, means closed to applications for inclusion in the list of patients other than from immediate family members of registered patients;

“contraceptive services” means the services described in paragraph 3(2) of Schedule 1;

“contract” means a general medical services contract under Article 57 of the Order;

“contractor’s list of patients” means the list prepared and maintained by the Board under paragraph 14 of Schedule 5;

“core hours” means the period beginning at 8am and ending at 6.30pm on any day from, and including, Monday to Friday except a public holiday and a local holiday agreed with the Board;

“dispensing services” means the provision of drugs, medicines or appliances that may be provided by a medical practitioner in accordance with arrangements made under regulation 11 of the Pharmaceutical Regulations;

“disqualified” means local or general disqualification by the Tribunal under paragraph 3(2) of Schedule 11 to the Order[^f00007] (or a decision under provisions in operation in England, Wales or Scotland corresponding to local or general disqualification), but does not include conditional disqualification under paragraph 4 of Schedule 1 to the Order;

“Drug Tariff” means the statement published under regulation 9 of the Pharmaceutical Regulations;

“enhanced services” are –services other than essential services, additional services or out of hours services; oressential services, additional services or out of hours services or an element of such a service that a contractor agrees under the contract to provide in accordance with specifications set out in a plan, which requires of the contractor an enhanced level of service provision compared to that which it needs generally to provide in relation to that service or element of service;

“essential services” means the services required to be provided in accordance with regulation 15;

“Family Practitioner Services Independent Appeal Panel” means the body established under regulation 3 of the Health and Social Care (Family Practitioner Services Independent Appeal Panel) Regulations (Northern Ireland) 2022[^f00015];”

“general medical practitioner” means –from the coming into operation of Article 10 of the 2003 Order, a medical practitioner whose name is included in the General Practitioner Register ..., anduntil the coming into operation of that Article, a medical practitioner who is either –until the coming into operation of paragraph 22 of Schedule 8 to the 2003 Order, suitably experienced within the meaning of Article 8(2) of the Health and Personal Social Services (Northern Ireland) Order 1978[^f00008], section 31(2) of the National Health Service Act 1977[^f00009] or section 21 of the National Health Service (Scotland) Act 1978[^f00010] or a person who has an acquired right to practise as a general medical practitioner pursuant to regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994 ; orupon the coming into operation of paragraph 22 of Schedule 8 to the 2003 Order, an eligible general practitioner pursuant to that paragraph...;

“General Practitioner Register” means the register kept by the General Medical Council under Article 10 of the 2003 Order;

“global sum” has the same meaning as in the Statement of Financial Entitlements;

“GP Registrar” means a medical practitioner who is being trained in general practice by –until the coming into operation for all purposes of Article 4(5)(d) of the 2003 Order, a general medical practitioner who –has been approved for that purpose by the Joint Committee on Postgraduate Training for General Practice under regulation 7 of the Medical Practitioners (Vocational Training) Regulations (Northern Ireland) 1998, andperforms primary medical services; andfrom the coming into operation for all purposes of that Article, a general medical practitioner who is approved under that Article for the purpose of providing training under Article 5(1)(c)(i) of the 2003 Order, whether as part of training leading to the award of a CCT or otherwise;”.

“Health Board” means a Health Board established under section 2 of the National Health Service (Scotland) Act 1978[^f00012];

“health services body” means –any person or body referred to in Article 8(2) of the 1991 Order;persons entering into a contract who are to be regarded as a health services body in accordance with regulation 10 (health services body status);

“HSS contract” has the meaning assigned to it by Article 8 of the 1991 Order;

“immediate family member” means –a spouse or civil partner ,a person (whether or not of the opposite sex) whose relationship with the registered patient has the characteristics of the relationship between husband and wife,a parent or step-parent,a son,a daughter,a child of whom the registered patient is –the guardian, orthe person with whom the child has been placed by an authority under Article 27(2) of the Children (Northern Ireland) Order 1995[^f00013], ora grandparent;

“independent nurse prescriber” means a person –who is either engaged or employed by the contractor or is a party to the contract,who is registered in the Nursing and Midwifery Register, and –against whose name in that register is recorded an annotation signifying that he is qualified to order drugs, medicines and appliances as a community practitioner nurse prescriber, a nurse independent prescriber or as a nurse independent/supplementary prescriber;is also recorded in that register;

“independent prescriber” means—a chiropodist or podiatrist independent prescriber,an independent nurse prescriber,an optometrist independent prescriber,a paramedic independent prescriber,a pharmacist independent prescriber,a physiotherapist independent prescriber, anda therapeutic radiographer independent prescriber;

“licensing authority” shall be construed in accordance with regulation 6 of the Human Medicines Regulations 2012 ;

“licensing body” means any body that licenses or regulates any profession;

“limited partnership” means a partnership registered in accordance with section 5 of the Limited Partnerships Act 1907[^f00015];

“Local Health Board” means a body established under section 16BA of the National Health Services Act 1977[^f00016];

“Local Medical Committee” means the committee of that name recognised by the Board under Article 55B of the Order^f00017 ;

“maternity medical services” means the services described in paragraph 7 of Schedule 1;

“medical card” means a card issued by the RBSO , NHS England , a Local Health Board, Health Authority or Health Board to a person for the purpose of enabling him to obtain, or establishing his title to receive, primary medical services;

“medical officer” means a medical practitioner who is –employed or engaged by the Department for Social Development, orprovided by an organisation in pursuance of a contract entered into with the Department for Social Development;

“Medical Register” means the registers kept under section 2 of the Medical Act 1983[^f00018];

“minor surgery” means the services described in paragraph 8(2) of Schedule 1;

“national disqualification” means a general disqualification by the Tribunal under paragraph 3(2)(b) of Schedule 11 to the Order or a decision under corresponding provisions in operation in England, Wales or Scotland;

“the dispute resolution procedure” means the procedure for resolution of disputes specified –in paragraphs 92 and 93 of Schedule 5; orin a case to which paragraph 36 of Schedule 5 applies, in that paragraph.

“normal hours” means those days and hours on which and the times at which services under the contract are normally made available and may be different for different services;

“the Northern Ireland Commissioner for Complaints” means the person appointed under section 36(1) of the Northern Ireland Constitution Act 1973[^f00019];

“NHS Foundation Trust” shall be construed in accordance with Part 1 of the Health and Social Care (Community Health and Standards) Act 2003[^f00020];

“NHS Trust” means a trust established under Part 1 of the National Health Service and Community Care Act 1990[^f00021];

“Nursing and Midwifery Register” means the register maintained by the Nursing and Midwifery Council under to the Nursing and Midwifery Order 2001[^f00022];

“open”, in relation to a contractor’s list of patients, means open to applications from patients in accordance with paragraph 15 of Schedule 5;

“optometrist independent prescriber” means a person—who is either engaged or employed by the contractor or is a party to the contract,who is registered in the register of optometrists maintained under Section 7(a) of the Opticians Act 1989[^f00006], andagainst whose name in that register is recorded an annotation signifying that he is qualified to order drugs, medicines and appliances as an optometrist independent prescriber;

“the Order” means the Health and Personal Social Services (Northern Ireland) Order 1972;

“the 1991 Order” means the Health and Personal Social Services (Northern Ireland) Order 1991;

“ the 2010 Order ;

“out of hours period” means –the period beginning at 6.30pm on any day from, and including, Monday to Thursday and ending at 8am on the following day;the period between 6.30pm on, and including, Friday and 8am on the following Monday; andany public holiday or local holiday agreed with the Board,and “part” of an out of hours period means any part of any one or more of the periods described in paragraphs (a) to (c);

“out of hours services” means services required to be provided in all or part of the out of hours period which –would be essential services if provided by a contractor to his registered patients in core hours, orare included in the contract as additional services funded under the global sum;

“paramedic independent prescriber” means a person—who is either engaged or employed by the contractor or is a party to the contract,who is registered in Part 8 of the register maintained under Article 5 of the Health and Social Work Professions Order 2001, andagainst whose name in that register is recorded an annotation signifying that he is qualified to order drugs, medicines and appliances as a paramedic independent prescriber;

“patient” means –registered patient,a temporary resident,persons to whom the contractor is required to provide immediately necessary or necessary treatment under regulation 15(6) or (8) respectively,any other person to whom the contractor has agreed to provide services under the contract, andany person for whom the contractor is responsible under regulation 31;

“Pharmaceutical Regulations” means the Pharmaceutical Services Regulations (Northern Ireland) 1997[^f00024];

“pharmacist independent prescriber” means a person—who is either engaged or employed by the contractor or is a party to the contract,who is registered in the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976 or the Register of Pharmaceutical Chemists maintained in pursuance of section 2(1) of the Pharmacy Act, andagainst whose name in that register is recorded an annotation signifying that he is qualified to order drugs, medicines and appliances as a pharmacist independent prescriber;

“physiotherapist independent prescriber” means a person—who is either engaged or employed by the contractor or is a party to the contract,registered in Part 9 of the register maintained under Article 5 of the Health and Social Work Professions Order 2001, andagainst whose name in that register is recorded an annotation signifying that he is qualified to order drugs, medicines and appliances as a physiotherapist independent prescriber;

...[^f00025]

“practice” means the business operated by the contractor for the purpose of delivering services under the contract;

“practice area” means the area referred to in regulation 18(1)(d);

“practice leaflet” means a leaflet drawn up in accordance with paragraph 71 of Schedule 5;

“practice premises” means an address specified in the contract as one at which services are to be provided under the contract;

“prescriber” means –a medical practitioner,... an independent prescriber , anda supplementary prescriber,who is either engaged or employed by the contractor or is a party to the contract;

“prescription form” means a form provided by the RBSO and issued by a prescriber to enable a person to obtain pharmaceutical services and does not include a repeatable prescription;

“prescription only medicine” means a medicine referred within the meaning of regulation 5(3) of the Human Medicines Regulations 2012

“primary medical services performers list” means the list of persons performing primary medical services prepared in accordance with regulations made under Article 57G of the Order[^f00026] (persons performing primary medical services);

“primary carer” means, in relation to an adult the person primarily caring for him;

...[^f00026]

“registered nursing home” means a nursing home in respect of which a person is registered under Part III of the Registered Homes (Northern Ireland) 1992[^f00027];

“registered patient” means –a person who is recorded by the Board as being on the contractor’s list of patients, ora person whom the contractor has accepted for inclusion on his list of patients, whether or not notification of that acceptance has been received by the Board and who has not been notified by the Board as having ceased to be on that list;

"regulation 24 category of visitor” means any person to whom regulation 24 of the Provision of Health Services to Persons not Ordinarily Resident Regulations (Northern Ireland) 2015 applies;

“relevant register” means –in relation to a nurse, the Nursing and Midwifery Register; andin relation to a pharmacist, the register maintained in pursuance of section 2(1) of the Pharmacy Act 1954[^f00028] or the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976[^f00029];in relation to an optometrist, the register maintained by the General Optical Council in pursuance of Section 7(a) of the Opticians Act 1989; andthe part of the register maintained under Article 5 of the Health and Social Work Professions Order 2001 relating to—chiropodists and podiatrists;dietitians;paramedics;physiotherapists; andradiographers;

“repeat dispensing services” means pharmaceutical services which involve the provision of drugs, medicines or appliances by a chemist in accordance with a repeatable prescription;

“repeatable prescribing services” means services which involve the prescribing of drugs, medicines or appliances on a repeatable prescription;

“repeatable prescription” means a prescription contained in a form provided by the Agency and issued by a prescriber to enable a person to obtain pharmaceutical services and which –is generated by a computer but signed by a prescriber, andindicates that the drugs, medicines or appliances ordered on that form may be provided more than once and specifies the number of occasions on which they may be provided.

“restricted availability appliance” means an appliance which is approved for particular categories of persons or particular purposes only;

“Statement of Financial Entitlements” means the directions given by the Department under Article 57C of the Order[^f00030];

...[^f00031]

“Scheduled drug” means –a drug, medicine or other substance specified in any directions given by the Department under Article 57D of the Order[^f00032] as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract, orexcept where the conditions in paragraph 40(2) of Schedule 5 are satisfied, a drug, medicine or other substance which is specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which can only be ordered for specified patients and specified purposes;

“supplementary prescriber” means a person –who is either engaged or employed by the contractor or is a party to the contract,whose name is registered in –Parts 1, 3, 5, 8, 10, 11, 12, 13, 14 or 15 of the Nursing and Midwifery Register,the Register of Pharmaceutical Chemists maintained in pursuance of section 2(1) of the Pharmacy Act 1954, ...the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976, ... the part of the register maintained by the Health Professions Council in pursuance of Article 5 of the Health Professions Order 2001 relating to—chiropodists and podiatrists;physiotherapists; orradiographers: diagnostic or therapeutic; dietitians; andparamedics; or the register maintained by the General Optical Council in pursuance of Section 7(a) of the Opticians Act 1989;against whose name is recorded in the relevant register an annotation signifying that he is qualified to order drugs, medicines and appliances as a supplementary prescriber;

“temporary resident” means a person accepted by the contractor as a temporary resident under paragraph 16 of Schedule 5 and for whom the contractor’s responsibility has not been terminated in accordance with that paragraph;

“therapeutic radiographer independent prescriber” means a radiographer—who is either engaged or employed by the contractor or is a party to the contract,who is registered in Part 11 of the register maintained under Article 5 of the Health and Social Work Professions Order 2001, andagainst whose name in that register is recorded—an entitlement to use the title “therapeutic radiographer”, andan annotation signifying that he is qualified to order drugs, medicines and appliances as a therapeutic radiographer independent prescriber;

“the Tribunal” means the body constituted under Schedule 11 to the Order[^f00033];

“working day” means any day apart from Saturday, Sunday, a public holiday or a local holiday agreed with the Board;

“writing”, except in paragraph 96(1) of Schedule 5, includes electronic mail and “written” shall be construed accordingly.

PART 2 — CONTRACTORS

Conditions: General

3

Subject to the provisions of any order made by the Department under Article 5 of the Primary Medical Services (Northern Ireland) Order 2004 (general medical services: transitional)[^f00034], a Board may only enter into a contract if the conditions set out in regulations 4 and 5 are met.

Conditions relating solely to medical practitioners

4

(1) In the case of a contract to be entered into with a medical practitioner, that practitioner must be a general medical practitioner.

(2) In the case of a contract to be entered into with two or more individuals practising in partnership –

(a) at least one partner (who must not be a limited partner) must be a general medical practitioner; and

(b) any other partner who is a medical practitioner must –

(i) be a general medical practitioner, or

(ii) be employed by a Board, a Health and Social Services Trust,... a Local Health Board, (in England and Wales and Scotland) NHS Trust, an NHS Foundation Trustor, (in Scotland) a Health Board;

(3) In the case of a contract to be entered into with a company limited by shares –

(a) at least one share in the company must be legally and beneficially owned by a general medical practitioner; and

(b) any other share or shares in the company that are legally and beneficially owned by a medical practitioner must be so owned by –

(i) a general medical practitioner, or

(ii) a medical practitioner who is employed by a Board,... Local Health Board, in England and Wales and Scotland an NHS Trust, or in (Scotland) a Health Board.

(4) In paragraphs (1), (2)(a) and (3)(a), “general medical practitioner” does not include a medical practitioner whose name is included in the General Practitioner Register by virtue of—

(a) article 4(3) of the 2010 Order (general practitioners eligible for entry in the General Practitioner Register) because of an exemption under regulation 5(1)(d) of the one or more of the sets of Regulations specified in paragraph (5);

(b) article 6(2) of the 2010 Order (persons with acquired rights) by virtue of being a restricted services principal (within the meaning of one or more of the sets of Regulations specified in paragraph (6) included in a list specified in that article; or

(5) The regulations referred to in paragraph (4)(a) are the Medical Practitioners (Vocational Training) Regulations (Northern Ireland) 1998, the National Health Service (Vocational Training for General Medical Practice) Regulations 1997, and the National Health Service (Vocational Training for General Medical Practice) (Scotland) Regulations 1998.

(6) The Regulations referred to in paragraph (4)(b) are the General Medical Services Regulations Northern Ireland 1997, National Health Service (General Medical Services) Regulations 1992 and the National Health Service (General Medical Services) (Scotland) Regulations 1995.

General condition relating to all contracts

5

(1) It is a condition in the case of a contract to be entered into –

(a) with a medical practitioner, that the medical practitioner;

(b) with two or more individuals practising in partnership, that any individual or the partnership; and

(i) the company,

(ii) any person legally and beneficially owning a share in the company, and

(iii) any director or secretary of the company,

must not fall within paragraph (2).

(2) A person falls within this paragraph if –

(a) he is the subject of a national disqualification;

(b) subject to paragraph (3), he is disqualified or suspended (other than by an interim suspension order or direction pending an investigation) from practising by any licensing body anywhere in the world;

(c) within the period of five years prior to the signing of the contract or commencement of the contract, whichever is the earlier, he has been dismissed (otherwise than by reason of redundancy) from any employment by a health services body unless he has subsequently been employed by that health services body or another health services body and paragraph (4) applies to him, or that dismissal was the subject of a finding of unfair dismissal by any competent tribunal or court;

(d) within the period of five years prior to signing the contract or commencement of the contract, whichever is the earlier, he has been disqualified from a primary medical service performers list unless his name has subsequently been included in such a list;

(e) he has been convicted in the United Kingdom of murder;

(f) he has been convicted in the United Kingdom of a criminal offence other than murder, committed on or after 1st April 2004, and has been sentenced to a term of imprisonment of over six months;

(g) subject to paragraph (5) he has been convicted elsewhere of an offence –

(i) which would if committed in Northern Ireland constitute murder; or

(ii) committed on or after 1st April 2004, which would if committed in Northern Ireland constitute a criminal offence other than murder, and been sentenced to a term of imprisonment of over six months;

(h) he has been convicted of an offence referred to in Schedule 1 to the Children and Young Persons Act (Northern Ireland) 1968[^f00035], Schedule 1 to the Children and Young Persons Act 1933[^f00036] (offences against children and young persons with respect to which special provisions of this Act apply) or Schedule 1 to the Criminal Procedure (Scotland) Act 1955 (offences against children under the age of 17 years to which special provisions apply)[^f00037], committed on or after 29th March 2004;

(i) he has –

(i) been adjudged bankrupt or had sequestration of his estate awarded unless (in either case) he has been discharged or the bankruptcy order has been annulled;

(ii) been made the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986[^f00038] or Schedule 2A to the Insolvency (Northern Ireland) Order 1989 or a debt relief restrictions order or an interim debt relief restrictions order under Schedule 4ZB to the Insolvency Act 1986 or Schedule 2ZB to the Insolvency (Northern Ireland) Order 1989 unless that order has ceased to have effect or has been annulled, or

(iii) made a composition or arrangement with, or granted a trust deed for, his creditors unless he has been discharged in respect of it;

(ia) become a person in relation to whom a moratorium period under a debt relief order made under Part 7A of the Insolvency Act 1986 or Part 7A of the Insolvency (Northern Ireland) Order 1989 applies;

(j) an administrator, administrative receiver or receiver is appointed in respect of him;

(k) within the period of five years prior to signing the contract or commencement of the contract, whichever is the earlier, he has been –

(i) removed from the office of charity trustee or trustee for a charity by an order made by the Charity Commissioners or the High Court on the grounds of any misconduct or mismanagement in the administration of the charity for which he was responsible or to which he was privy, or which he by his conduct contributed to or facilitated; or

(ii) removed under section 7 of the Law Reform (Miscellaneous Provisions) (Scotland) Act 1990[^f00039] (powers of the Court of Session to deal with management of charities) or under section 34 of the Charities and Trustee Investment (Scotland) Act 2005 (powers of Court of Session) , from being concerned in the management or control of any body; or

(l) he is subject to a disqualification order under the Companies Directors Disqualification (Northern Ireland) Order 2002[^f00040], the Company Directors Disqualification Act 1986[^f00041], or to an order made under section 429(2)(b) of the Insolvency Act 1986 (failure to pay under county court administration order).

(3) A person shall not fall within paragraph (2)(b) where the Board is satisfied that the disqualification or suspension from practising is imposed by a licensing body outside the United Kingdom and it does not make the person unsuitable to be –

(a) a contractor;

(b) a partner, in the case of a contract with two or more individuals practising in partnership;

(i) a person legally and beneficially holding a share in the company, or

(ii) a director or secretary of the company,

as the case may be.

(4) Where a person has been employed as a member of a health care profession any subsequent employment must also be as a member of that profession.

(5) A person shall not fall within paragraph (2)(g) where the Board is satisfied that the conviction does not make the person unsuitable to be –

(a) a contractor;

(b) a partner, in the case of a contract with two or more individuals practising in partnership;

(i) a person legally and beneficially holding a share in the company; or

(ii) a director or secretary of the company,

as the case may be.

Reasons

6

(1) Where a Board is of the view that the conditions in regulation 4 or 5 for entering into a contract are not met it shall notify in writing the person intending to enter into the contract of its view and of its reasons for that view and of his right of appeal under regulation 7.

(2) The Board shall also notify in writing of its view and its reasons for that view any person legally and beneficially owning a share in, or a director or secretary of, a company that is notified under paragraph (1) where its reason for the decision relates to that person or persons.

Appeal

7

A person who has been served with a notice under regulation 6(1) may appeal to the Family Practitioner Services Independent Appeal Panel against the decision of the Department by giving notice in writing to the Family Practitioner Services Independent Appeal Panel within the period of 28 days beginning on the day that the Department served its notice.

Prescribed period under Article 15C(b)(iii) of the Order

8

The period prescribed for the purposes of Article 15C(1)(b)(iii) of the Order (persons with whom agreements may be made)[^f00042] is six months.

PART 3 — PRE-CONTRACT DISPUTE RESOLUTION

Pre-contract disputes

9

(1) Except where both parties to the prospective contract are health services bodies (in which case Article 8(5) of the 1991 Order (HSS Contracts) applies), if, in the course of negotiations intending to lead to a contract, the prospective parties to that contract are unable to agree on a particular term of the contract, either party may refer the dispute to the Family Practitioner Services Independent Appeal Panel to consider and determine the matter.

(2) Disputes referred to the Family Practitioner Services Independent Appeal Panel in accordance with paragraph (1) or Article 8(5) of the 1991 Order shall be considered and determined in accordance with the provisions of paragraphs 93(3) to (13) and 94(1) of Schedule 5, and paragraph (3) (where it applies).

(3) In the case of a dispute referred to the Family Practitioner Services Independent Appeal Panel under paragraph (1), the determination –

(a) may specify terms to be included in the proposed contract;

(b) may require the Department to proceed with the proposed contract, but may not require the proposed contractor to proceed with the proposed contract; and

PART 4 — HEALTH SERVICES BODY STATUS

Health services body status

10

(1) Where a proposed contractor elects in a written notice served on the Board at any time prior to the contract being entered into to be regarded as a health services body for the purposes of Article 8 of the 1991 Order, he shall be so regarded from the date on which the contract is entered into.

(2) If, pursuant to paragraph (1) or (5) a contractor is to be regarded as a health services body, it shall not affect the nature of, or any rights or liabilities arising under, any other contract with a health services body entered into by a contractor before the date on which the contractor is to be so regarded.

(3) Where a contract is made with an individual medical practitioner or two or more persons practising in partnership, and that individual, or that partnership is to be regarded as a health services body in accordance with paragraph (1) or (5), the contractor shall, subject to paragraph (4), continue to be regarded as a health services body for the purposes of Article 8 of the 1991 Order for as long as that contract continues irrespective of any change in –

(a) the partners comprising the partnership;

(b) the status of the contractor from that of an individual medical practitioner to that of a partnership; or

(4) A contractor may at any time request in writing a variation of the contract to include provision in or remove provision from the contract that the contract is an HSS contract, and if he does so –

(a) the Board shall agree to the variation; and

(b) the procedure in paragraph 96(1) of Schedule 5 shall apply.

(5) If, pursuant to paragraph (4), the Board agrees to the variation to the contract, the contractor shall –

(a) be regarded; or

(b) subject to paragraph (7), cease to be regarded

as a health services body for the purposes of Article 8 of the 1991 Order from the date that variation is to take effect pursuant to paragraph 96(1) of Schedule 5.

(6) Subject to paragraph (7), a contractor shall cease to be a health services body for the purposes of Article 8 of the 1991 Order if the contract terminates.

(7) Where a contractor ceases to be a health services body pursuant to –

(a) paragraph (5) or (6), he shall continue to be regarded as a health services body for the purposes of being a party to any other HSS contract entered into after he became a health services body but before the date on which the contractor ceased to be a health services body (for which purpose he ceases to be such a body on the termination of that HSS contract);

(b) paragraph (5), he shall, if he or the Board has referred any matter to the dispute resolution procedure before he ceases to be a health services body, be bound by the determination of the adjudicator as if the dispute had been referred pursuant to paragraph 92 of Schedule 5;

(c) paragraph (6), he shall continue to be regarded as a health services body for the purposes of the dispute resolution procedure where that procedure has been commenced –

(i) before the termination of the contract, or

(ii) after the termination of the contract, whether in connection with or arising out of the termination of the contract or otherwise,

for which purposes he ceases to be such a body on the conclusion of that procedure.

PART 5 — CONTRACTS: REQUIRED TERMS

Parties to the contract

11

A contract must specify –

(a) the names of the parties;

(b) in the case of a partnership –

(i) whether or not it is a limited partnership, and

(ii) the names of the partners and, in the case of a limited partnership, their status as a general or limited partner; and

12

If the contractor is to be regarded as a health services body pursuant to regulation 10, the contract must state that it is an HSS contract.

Contracts with individuals practising in partnership

13

(1) Where the contract is with two or more individuals practising in partnership, the contract shall be treated as made with the partnership as it is from time to time constituted, and the contract shall make specific provision to this effect.

(2) Where the contract is with two or more individuals practising in partnership, the contractor must be required by the terms of the contract to ensure that any person who becomes a member of the partnership after the contract has come into operation is bound automatically by the contract whether by virtue of a partnership deed or otherwise.

Duration

14

(1) Except in the circumstances specified in paragraph (2), a contract must provide for it to subsist until it is terminated in accordance with the terms of the contract or the general law.

(2) The circumstances referred to in paragraph (1) are that the Board wishes to enter into a temporary contract for a period not exceeding twelve months for the provision of services to the former patients of a contractor, following the termination of that contractor’s contract.

(3) Either party to a prospective contract to which paragraph (2) applies may, if it wishes to do so, invite the Local Medical Committee for the area ...to participate in the negotiations intending to lead to such a contract.

Essential services

15

(1) For the purposes of Article 57A of the Order (requirement to provide certain primary medical services), the services which must be provided under a general medical services contract (“essential services”) are the services described in paragraphs (3), (5), (6) and (8).

(2) Subject to regulation 20, a contractor must provide the services described in paragraphs (3) and (5) throughout the core hours.

(3) The services described in this paragraph are services required for the management of his r registered patients and temporary residents who are, or believe themselves to be –

(a) ill, with conditions from which recovery is generally expected;

(b) terminally ill; or

delivered in the manner determined by the practice in discussion with the patient.

(4) For the purposes of paragraph (3) –

“disease” means a disease included in the list of three-character categories contained in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems[^f00043]; and

“management” includes –offering consultation and, where appropriate, physical examination for the purpose of identifying the need, if any, for treatment or further investigation; andthe making available of such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the Order and liaison with other health care professionals involved in the patient’s treatment and care.

(5) The services described in this paragraph are the provision of appropriate ongoing treatment and care to all registered patients and temporary patients taking account of their specific needs including –

(a) the provision of advice in connection with the patient’s health, including relevant health promotion advice; and

(b) the referral of the patient for other services under the Order.

(6) A contractor must provide primary medical services required in core hours for the immediately necessary treatment of any person to whom the contractor has been requested to provide treatment owing to an accident or emergency at any place in his practice area.

(7) In paragraph (6), “emergency” includes any medical emergency whether or not related to services provided under the contract.

(8) A contractor must provide primary medical services required in core hours for the immediately necessary treatment of any person falling within paragraph (9) who requests such treatment, for the period specified in paragraph (10).

(9) A person falls within paragraph (8) if he is a person –

(a) whose application for inclusion in the contractor’s list of patients has been refused in accordance with paragraph 17 of Schedule 5 and who is not registered with another provider of essential services (or their equivalent) in the area of the Board;

(b) whose application for acceptance as a temporary resident has been rejected under paragraph 17 of Schedule 5; or

(10) The period referred to in paragraph (8) is –

(a) in the case of paragraph (9)(a), 14 days beginning with and including the date on which that person’s application was rejected (or, as the case may be, with and including the date on which the contractor requested the removal of that person from his list of patients) or until that person has been subsequently registered elsewhere for the provision of essential services (or their equivalent), whichever occurs first;

(b) in the case of paragraph (9)(b), 14 days beginning with and including the date on which that person’s application was rejected or until that person has been subsequently accepted elsewhere as a temporary resident, whichever occurs first; and

(c) in the case of paragraph (9)(c), 24 hours or such shorter period as the person is present in the contractor’s practice area.

Additional services

16

A contract which includes the provision of any additional services must –

(a) in relation to all such services as are included in the contract, contain a term which has the same effect as that specified in paragraph 1 of Schedule 1; and

(b) in relation to each such service as is included in the contract, contain terms which have the same effect as those specified in Schedule 1 which are relevant to that service.

Opt outs of additional and out of hours services

17

(1) Where a contract provides for the contractor to provide an additional service that is to be funded through the global sum the contract must contain terms relating to the procedure for opting out of additional services which have the same effect as those specified in paragraphs 1, 2, 3 and 6 of Schedule 2 except paragraph 3(12) to (14).

(2) Where a contract which is entered into before 1st October 2004 provides for the contractor to provide out of hours services pursuant to regulation 30 or 31, the contract must contain terms relating to the procedure for opting out of those services which have the same effect as those specified in paragraphs 4, 5 and 6 of Schedule 2 except paragraphs 4(9) and 5(17) in so far as those paragraphs relate to paragraph 3(12) to (14).

(3) Where a contract which is entered into on or after 1st October 2004 provides for the contractor to provide out of hours services pursuant to regulation 29, the contract must contain terms relating to the procedure for opting out of those services which have the same effect as those specified in paragraphs 4 and 6 of Schedule 2 except paragraph 4(9) in so far as that paragraph relates to paragraph 3(12) to (14).

(4) Paragraph 3(12) to (14) and paragraphs 4(9) and 5(17) in so far are those paragraphs relate to paragraph 3(12) to (14) of Schedule 2 shall have effect in relation to the matters set out in those paragraphs.

Services generally

18

(1) A contract must specify –

(a) the services to be provided;

(b) subject to paragraph (2), the address of each of the premises to be used by the contractor or any sub-contractor for the provision of such services;

(d) the area as respects which persons resident in it will, subject to any other terms of the contract relating to patient registration, be entitled to –

(i) register with the contractor, or

(ii) seek acceptance by the contractor as a temporary resident; and

(e) whether, at the date on which the contract comes into operation, the contractor’s list of patients is open or closed.

(1A) A contract—

(a) may also specify an area, other than the area referred to in paragraph 1(d), which is to be known as the outer boundary area as respects which a patient—

(i) who moves into that outer boundary area to reside; and

(ii) who wishes to remain on the contractor’s list of patients,

may remain on that list if the contractor so agrees, notwithstanding that the patient no longer resides in the area referred to in paragraph (1)(d); and

(b) which specifies an outer boundary must specify that where a patient remains on the contractor’s list of patients as a consequence of sub-paragraph (a) the outer boundary area is to be treated as part of the practice area for the purposes of the application of any other terms and conditions of the contract in respect of that patient.

(2) The premises referred to in paragraph (1)(b) do not include –

(a) the homes of patients; or

(b) any other premises where services are provided on an emergency basis.

(3) Where, on the date on which the contract is signed, the Board is not satisfied that all or any of the premises specified in accordance with paragraph (1)(b) meet the requirements set out in paragraph 1 of Schedule 5, the contract must include a plan, drawn up jointly by the Board and the contractor, which specifies –

(a) the steps to be taken by the contractor to bring the premises up to the relevant standard;

(b) any financial support that may be available from the Board; and

(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19

(1) Except in the case of the services referred to in paragraph (2), the contract must state the period (if any) for which the services are to be provided.

(2) The services referred to in paragraph (1) are –

(a) essential services;

(b) additional services funded under the global sum; and

20

A contract must contain a term which requires the contractor in core hours-

(a) to provide –

(i) essential services, and

(ii) additional services funded under the global sum,

at such times, within core hours, as are appropriate to meet the reasonable needs of his patients; and

(b) to have in place arrangements for his patients to access such services throughout the core hours in case of emergency.

Certificates

21

(1) A contract must contain a term which has the effect of requiring the contractor to issue free of charge to a patient or his personal representatives any medical certificate of a description prescribed in column 1 of Schedule 3, which is reasonably required under or for the purposes of the statutory provisions specified in relation to the certificate in column 2 of that Schedule, except where, for the condition to which the certificate relates, the patient –

(a) is being attended by a medical practitioner who is not –

(i) employed or engaged by the contractor;

(ii) in the case of a contract with two or more individuals practising in partnership, one of those individuals; or

(iii) in the case of a contract with a company limited by shares, one of the persons legally or beneficially owning shares in that company; or

(b) is not being treated by or under the supervision of a health care professional.

(2) The exception in paragraph (1)(a) does not apply where the certificate is issued in accordance with regulation 2(1) of the Social Security (Medical Evidence) Regulations (Northern Ireland) 1976 (Evidence of incapacity for work, limited capability for work and confinement) or regulation 2(1) of the Statutory Sick Pay (Medical Evidence) Regulations (Northern Ireland) 1985 (Medical information).

Finance

22

(1) Subject to paragraph (2), the contract must contain a term which has the effect of requiring payments to be made under the contract promptly and in accordance with both the terms of the contract and any other conditions relating to the payment contained in directions given by the Department under Article 57C of the Order[^f00045].

(2) The obligation referred to in paragraph (1) is subject to any right the Board may have to set off against any amount payable to the contractor under the contract any amount –

(a) that is owed by the contractor to the Board under the contract; or

(b) that the Board may withhold from the contractor in accordance with the terms of the contract or any other applicable provisions contained in directions given by the Department under Article 57C of the Order.

23

The contract must contain a term to the effect that where, pursuant to directions under Article 57C of the Order, a Board is required to make a payment to a contractor under a contract but subject to conditions, those conditions are to be a term of the contract.

Fees and charges

24

(1) The contract must contain terms relating to fees and charges which have the same effect as those set out in paragraphs (2) to (4).

(2) The contractor shall not, either himself or through any other person, demand or accept from any patient of his a fee or other remuneration, for his own or another’s benefit, for –

(a) provision of any treatment whether under the contract or otherwise; or

(b) any prescription or repeatable prescription for any drug, medicine or appliance,

except in the circumstances set out in Schedule 4.

(3) Where a person applies to a contractor for the provision of essential services and claims to be on that contractor’s list of patients, but fails to produce his medical card on request and the contractor has reasonable doubts about that person’s claim, the contractor shall give any necessary treatment and shall be entitled to demand and accept a reasonable fee in accordance with paragraph 1(d) of Schedule 4 , subject to the provision for repayment contained in paragraph (4).

(4) Where a person from whom a contractor received a fee under paragraph 1(d) of Schedule 4 applies to the Board for a refund within 14 days of payment of the fee (or such longer period not exceeding a month as the Board may allow if it is satisfied that the failure to apply within 14 days was reasonable) and the Board is satisfied that the person was on the contractor’s list of patients when the treatment was given, the Board may recover the amount of the fee from the contractor, by deduction from his remuneration or otherwise, and shall pay that amount to the person who paid the fee.

Arrangements on termination

25

A contract shall make suitable provision for arrangements on termination of a contract, including the consequences (whether financial or otherwise) of the contract ending.

Other contractual terms

26

(1) A contract must, unless it is of a type or nature to which a particular provision does not apply, contain other terms which have the same effect as those specified in Schedule 5 except paragraphs 31(6) to (8), 35(5) to (9), 36(5) to (17), 93(5) to (14) and 94.

(2) The paragraphs specified in paragraph (1) shall have effect in relation to the matters set out in those paragraphs.

PART 6 — FUNCTIONS OF LOCAL MEDICAL COMMITTEES

27

(1) The functions of a Local Medical Committee which are prescribed for the purposes of Article 55B(7) (Local Medical Committees) of the Order[^f00046] are –

(a) the consideration of any complaint made to it by any medical practitioner against a medical practitioner specified in paragraph (2) providing services under a contract in the relevant area involving any question of the efficiency of those services;

(b) the reporting of the outcome of the consideration of such complaint to the Board with whom the contract is held in cases where that consideration gives rise to any concerns relating to the efficiency of services provided under a contract;

(c) the making of arrangements for the medical examination of a medical practitioner specified in paragraph (2), where the contractor or the Board is concerned that the medical practitioner is incapable of adequately providing services under the contract and it so requests with the agreement of the medical practitioner concerned; and

(d) the consideration of the report of any medical examination arranged in accordance with sub-paragraph (c) and the making of a written report as to the capability of the medical practitioner of adequately providing services under the contract to the medical practitioner concerned, the contractor and the Board with whom the contractor holds a contract.

(2) The medical practitioner referred to in paragraph (1)(a) and (c) is a medical practitioner who is –

(a) a contractor;

(b) one of two or more individuals practising in partnership who hold a contract; or

(3) In this regulation, “the relevant area” means the area for which the Local Medical Committee is formed.

PART 7 — TRANSITIONAL PROVISIONS

Commencement

28

The contract shall provide for services to be provided under it from any date after 31st March 2004.

Additional services

29

(1) Where the contract is with one of the persons specified in paragraph (2), the contract must, subject to regulation 17, provide for the contractor to provide in core hours to the contractor’s registered patients and persons accepted by him as temporary residents, such of the additional services as are equivalent to services which that medical practitioner was providing to his patients on the date that the contract is entered into except to the extent that –

(a) ... the provision of those services by that medical practitioner was due to come to an end on or before the date on which services are required to start being provided under the contract; ... or

(b) ...prior to the signing of the contract, the Board has accepted in writing a written request from the contractor that the contract should not require him to provide all or any of those additional services.

(2) The persons referred to in paragraph (1) are –

(a) an individual medical practitioner who, on 31st March 2004, was providing services under Article 56 of the Order (arrangements for general medical services);

(b) two or more individuals practising in partnership at least one of whom was, on 31st March 2004, a medical practitioner providing services under that section; or

(c) company in which one or more of the shareholders was, on 31st March 2004, a medical practitioner providing services under that Article.

(3) This regulation applies only to contracts under which services are to be provided from 1st April 2004.

Out of hours services

30

(1) Subject to paragraph 10 of Schedule 5, a contract under which services are to be provided before 1st January 2005 (whether or not such services will be provided after that date) must provide for the services specified in paragraph (2) to be provided throughout the out of hours period unless –

(a) the Board has accepted in writing, prior to the signing of the contract, a written request from the contractor that the contract should not require the contractor to make such provision;

(b) the contract is, at the date on which it is signed, with –

(i) a medical practitioner who, on or before 31st March 2004, made an arrangement to transfer his obligations under the terms of service to another medical practitioner under paragraph 20(2) of Schedule 2 to the General Medical Services Regulations (Northern Ireland) 1997[^f00047],

(ii) a partnership in which all of the partners who are general medical practitioners have made arrangements on or before 31st March 2004 to transfer their obligations under the terms of service to other medical practitioners under that paragraph, or

(iii) a company in which all of the general medical practitioners who own shares in that company have on or before 31st March 2004 made arrangements to transfer their obligations under the terms of service to other medical practitioners under that paragraph ;

(d) the contract has been otherwise varied to exclude a requirement to make such provision.

(2) The services referred to in paragraph (1) are –

(a) the services which must be provided in core hours under regulation 15; and

(b) such additional services as are included in the contract pursuant to regulation 29.

31

(1) Where the contract is with –

(a) an individual medical practitioner who is, or was on 31st March 2004, responsible for providing services during all or part of the out of hours period to the patients of a medical practitioner who meets the requirements in paragraph (2);

(b) two or more individuals practising in partnership at least one of whom is, or was on 31st March 2004, a medical practitioner responsible for providing such services; or

(c) a company in which one or more of the shareholders is, or was on 31st March 2004, a medical practitioner responsible for providing such services,

the contract with that contractor must require the contractor to continue to provide such services to the patients of the exempt contractor until the happening of one of the events in paragraph (3).

(2) The requirements referred to in paragraph (1)(a) are that –

(a) the medical practitioner had made an arrangement to transfer his obligations under the terms of service to another medical practitioner under paragraph 20(2) of Schedule 2 to the General Medical Services Regulations (Northern Ireland) 1997; and

(b) he –

(i) has entered or intends to enter into a contract which does not include out of hours services pursuant to regulation 30(1)(b)(i),

(ii) is one of two or more individuals practising in partnership who have entered or intends to enter into a contract which does not include out of hours services pursuant to regulation 30(1)(b) (ii), or

(iii) is the owner of shares in a company which has entered or intends to enter into a contract which does not include out of hours services pursuant to regulation 30(1)(b) (iii).

(3) The events referred to in paragraph (1) are –

(a) the contractor has opted out of the provision of out of hours services in accordance with paragraph 4 or 5 of Schedule 2; or

(b) the Board (and, if it is different, the Board with whom the exempt contractor holds his contract) has or have agreed in writing that the contractor need no longer provide some or all of those services to some or all of those patients.

(4) In this regulation “exempt contractor” means a contractor who is exempt from providing out of hours services pursuant to regulation 30(1)(b).

32

A contract which includes the provision of out of hours services pursuant to regulation 30 or 31 must contain terms which have the same effect as those set out in Schedule 6.

SCHEDULE 1 — ADDITIONAL SERVICES

Additional services generally

1

The contractor shall provide, in relation to each additional service, such facilities and equipment as are necessary to enable him properly to perform that service.

Cervical screening

2

(1) A contractor whose contract includes the provision of cervical screening services shall –

(a) provide all the services described in sub-paragraph (2); and

(b) make such records as are referred to in sub-paragraph (3),

in accordance with guidance relating to the Cervical Screening Programme issued from time to time by the Department.

(2) The services referred to in sub-paragraph (1)(a) are –

(a) the provision of any necessary information and advice to assist women identified by the Board as recommended nationally for a cervical screening test in making an informed decision as to participation in the Cervical Screening Programme;

(b) the performance of cervical screening tests on women who have agreed to participate in that Programme;

(d) ensuring that test results are followed up appropriately.

(3) The records referred to in sub-paragraph (1)(b) are an accurate record of the carrying out of a cervical screening test, the result of the test and any clinical follow up requirements.

Contraceptive services

3

(1) A contractor whose contract includes the provision of contraceptive services shall make available to all his patients who request such services the services described in sub-paragraph (2).

(2) The services referred to in sub-paragraph (1) are –

(a) the giving of advice about the full range of contraceptive methods;

(b) where appropriate, the medical examination of patients seeking such advice;

(c) the treatment of such patients for contraceptive purposes and the prescribing of contraceptive substances and appliances (excluding the fitting and implanting of intrauterine devices and implants);

(d) the giving of advice about emergency contraception and where appropriate, the supplying or prescribing of emergency hormonal contraception or, where the contractor has a conscientious objection to emergency contraception, prompt referral to another provider of primary medical services who does not have such conscientious objections;

(e) the provision of advice in cases of unplanned or unwanted pregnancy, including advice about the availability of free pregnancy testing in the practice area and, where appropriate, where the contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services who does not have such conscientious objections;

(f) the giving of initial advice about sexual health promotion and sexually transmitted infections; and

(g) the referral as necessary for specialist sexual health services, including tests for sexually transmitted infections.

Vaccinations and immunisations

4

(1) This paragraph applies to a contractor whose contract includes the provision of vaccines and immunisations but does not apply in the case of the provision of—

(a) childhood immunisations; and

(b) the combined Haemophilius influenza type B and Meningitis C booster vaccine.

(2) A contractor must comply with the requirements in sub-paragraphs (3) and (4).

(3) The contractor must—

(a) offer to provide patients, all vaccines and immunisations (other than those mentioned in sub-paragraph (1)(a) and (b)) of the type and in the circumstances which are set out in the GMS Statement of Financial Entitlements;

(b) taking into account the individual circumstances of the patient, consider whether immunisation ought to be administered by the contractor or other health professional or a prescription form ought to be provided for the purpose of the patient self-administering immunisation;

(d) record in the patient’s record, any refusal of the offer referred to in paragraph (3)(a);

(e) where the offer is accepted and immunisation is to be administered by the contractor or other health professional, include in the patient’s record—

(i) the patient’s consent to immunisation or the name of the person who gave consent to immunisation and that person’s relationship to the patient;

(ii) the batch numbers, expiry date and title of the vaccine;

(iii) the date of administration;

(iv) in the case where two vaccines are administered by injection, in close succession, the route of the administration and the injection site of each vaccine;

(v) any contraindications to the vaccine; and

(vi) any adverse reaction to the vaccine; and

(f) where the offer is accepted and the immunisation is not to be administered by the contractor or other health professional, issue a prescription form for the purpose of self-administration by the patient.

(4) The contractor must ensure that all staff involved in the administration of immunisations are trained in the recognition and initial treatment of anaphylaxis.

(5) In this paragraph “patient’s record” means the record which is kept in accordance with paragraph 68 of Schedule 5.

Childhood vaccinations and immunisations

5

(1) A contractor whose contract includes the provision of childhood vaccines and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The contractor shall –

(a) offer to provide to children, all vaccines and immunisations of the type and in the circumstances which are set out in the GMS Statement of Financial Entitlements ;

(b) provide appropriate information and advice to patients and, where appropriate, their parents, about such vaccines and immunisations;

(c) record in the patient’s record kept in accordance with paragraph 68 of Schedule 5 any refusal of the offer referred to in head (a);

(d) where the offer is accepted, administer the ...immunisations and include in the patient’s record kept in accordance with paragraph 68 of Schedule 5 –

(i) the name of the person who gave consent to the ...immunisation and his relationship to the patient;

(ii) the batch numbers, expiry date and title of the vaccine;

(iii) the date of administration;

(iv) in a case where two vaccines are administered in close succession, the route of administration and the injection site of each vaccine;

(v) any contraindications to the vaccine; and

(vi) any adverse reactions to the vaccine.

(3) The contractor shall ensure that all staff involved in administering vaccines are trained in the recognition and initial treatment of anaphylaxis.

Child health surveillance

6

(1) A contractor whose contract includes the provision of child health surveillance services shall, in respect of any child under the age of 5 for whom he has responsibility under the contract –

(a) provide all the services described in sub-paragraph (2), other than any examination so described which the parent refuses to allow the child to undergo, until the date upon which the child attains the age of five years; and

(b) maintain such records as are specified in sub-paragraph (3).

(2) The services referred to sub-paragraph (1)(a) are –

(a) the monitoring –

(i) by the consideration of any information concerning the child received by or on behalf of the contractor, and

(ii) on any occasion when the child is examined or observed by or on behalf of the contractor (whether pursuant to head (b) or otherwise),

of the health, well-being and physical, mental and social development (all of which characteristics are referred to in this paragraph as “development”) of the child while under the age of 5 years with a view to detecting any deviations from normal development;

(b) the examination of the child at a frequency that has been agreed with the Board in accordance with the nationally agreed evidence based programme set out in the fourth edition of “Health for all Children”[^f00049].

(3) The records mentioned in sub-paragraph (1)(b) are an accurate record of –

(a) the development of the child while under the age of 5 years, compiled as soon as is reasonably practicable following the first examination of that child and, where appropriate, amended following each subsequent examination; and

(b) the responses (if any) to offers made to the child’s parent for the child to undergo any examination referred to in sub-paragraph (2)(b).

Maternity medical services

7

(1) A contractor whose contract includes the provision of maternity medical services shall –

(a) provide to female patients who have been diagnosed as pregnant all necessary maternity medical services throughout the ante-natal period;

(b) provide to female patients and their babies all necessary maternity medical services throughout the post-natal period other than neo-natal checks;

(c) provide all necessary maternity medical services to female patients whose pregnancy has terminated as a result of miscarriage or abortion or, where the contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services who does not have such conscientious objections.

(2) In this regulation –

“ante-natal period” means the period from the start of the pregnancy to the onset of labour;

“maternity medical services” means – in relation to female patients (other than babies) all primary medical services relating to pregnancy, excluding intra partum care, and in relation to babies, any primary medical services necessary in their first 14 days of life;

“post-natal period” means the period starting from the conclusion of delivery of the baby or the patient’s discharge from secondary care services, whichever is the later, and ending on the fourteenth day after the birth.

Minor surgery

8

(1) A contractor whose contract includes the provision of minor surgery shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The contractor shall make available to patients where appropriate –

(a) curettage;

(b) cautery; and

(3) The contractor shall ensure that his record of any treatment provided under this paragraph includes the consent of the patient to that treatment.

SCHEDULE 2 — OPT OUTS OF ADDITIONAL AND OUT OF HOURS SERVICES

Opt outs of additional services: general

1

(1) In this Schedule –

“opt out notice” means a notice given under sub-paragraph (5) to permanently opt out or temporarily opt out of the provision of the additional service;

“permanent opt out” in relation to the provision of an additional service that is funded through the global sum means the termination of the obligation under the contract for the contractor to provide that service;

“permanent opt out notice” means an opt out notice to permanently opt out;

“preliminary opt out notice” means a notice given under sub-paragraph (2) that a contractor wishes to temporarily opt out or permanently opt out of the provision of an additional service;

“temporary opt out” in relation to the provision of an additional service that is funded through the global sum means the suspension of the obligation under the contract for the contractor to provide that service for a period of more than six months and less than twelve months and includes an extension of a temporary opt out and shall be construed accordingly; and

“temporary opt out notice” means an opt out notice to temporarily opt out.

(2) A contractor who wishes to permanently or temporarily opt out shall give to the Board in writing a preliminary opt out notice which shall state the reasons for wishing to opt out.

(3) As soon as is reasonably practicable and in any event within the period of 7 days beginning with the receipt of the preliminary opt out notice by the Board, the Board shall enter into discussions with the contractor concerning the support which the Board may give the contractor, or concerning other changes which the Board or the contractor may make, which would enable the contractor to continue to provide the additional service and the Board and the contractor shall use reasonable endeavours to achieve this aim.

(4) The discussions mentioned in sub-paragraph (3) shall be completed within the period of 10 days beginning with the date of the receipt of the preliminary opt out notice by the Board or as soon as reasonably practicable thereafter.

(5) Subject to sub-paragraph (9), if following the discussions mentioned in sub-paragraph (3), the contractor still wishes to opt out of the provision of the additional service, he shall send an opt out notice to the relevant Board.

(6) An opt out notice shall specify –

(a) the additional service concerned;

(b) whether the contractor wishes to –

(i) permanently opt out; or

(ii) temporarily opt out;

(d) the date from which the contractor would like the opt out to commence, which must –

(i) in the case of a temporary opt out be at least 14 days after the date of service of the opt out notice, and

(ii) in the case of a permanent opt out must be the day either three or six months after the date of service of the opt out notice, and

(e) in the case of a temporary opt out, the desired duration of the opt out.

(7) Where a contractor has given two previous temporary opt out notices within the period of three years ending with the date of the service of the latest opt out notice (whether or not the same additional service is concerned), the latest opt out notice shall be treated as a permanent opt out notice (even if the opt out notice says that he wishes to temporarily opt out).

(8) Paragraph 2 applies following the giving of a temporary opt out notice and paragraph 3 applies following the giving of a permanent opt out notice or a temporary opt out notice which pursuant to sub-paragraph (7) is treated as a permanent opt out notice.

(9) No temporary opt out notice may be served by a contractor prior to 1st April 2004.

Temporary opt outs and permanent opt outs following temporary opt outs

2

(1) As soon as is reasonably practicable and in any event within the period of 7 days beginning with and including the date of receipt of a temporary opt out notice under paragraph 1(5), the Board shall –

(a) approve the opt out notice and specify in accordance with sub-paragraphs (3) and (4) the date on which the temporary opt out is to commence and the date that it is to come to an end (“the end date”); or

(b) reject the opt out notice in accordance with sub-paragraph (2),

and shall notify the contractor of its decision as soon as possible, including reasons for its decision.

(2) A Board may reject the opt out notice on the ground that the contractor –

(a) is providing additional services to patients registered with another contractor or enhanced services; or

(b) has no reasonable need temporarily to opt out having regard to his ability to deliver the additional service.

(3) The date specified by the Board for the commencement of the temporary opt out shall wherever reasonably practicable be the date requested by the contractor in his opt out notice.

(4) Before determining the end date, the Board shall make reasonable efforts to reach agreement with the contractor.

(5) Where the Board approves an opt out notice, the contractor’s obligation to provide the additional service specified in the notice shall be suspended from the date specified by the Board in its decision under sub-paragraph (1), and shall remain suspended until the end date unless–

(a) the contractor and the Board agree in writing an earlier date, in which case the suspension shall come to an end on the earlier date agreed;

(b) the Board specifies a later date under sub-paragraph (6), in which case the suspension shall end on the later date specified;

(c) sub-paragraph (7) applies and the contractor refers the matter to the dispute resolution procedure or the court, in which case the suspension shall end–

(i) where the outcome of the dispute is to uphold the decision of the Department , on the day after the date of the decision of the Family Practitioner Services Independent Appeal Panel or the court,

(ii) where the outcome of the dispute is to overturn the decision of the Department , 28 days after the decision of the Family Practitioner Services Independent Appeal Panel or the court, or

(iii) where the contractor ceases to pursue the dispute resolution procedure or court proceedings, on the day after the date that the contractor withdraws his claim or the procedure is or proceedings are otherwise terminated by the Family Practitioner Services Independent Appeal Panel or the court;

(d) sub-paragraph (9) applies and –

(i) the Board refuses the contractor’s request for a permanent opt out within the period of 28 days ending with the end date, in which case the suspension shall come to an end 28 days after the end date,

(ii) the Board refuses the contractor’s request for a permanent opt out after the end date, in which case the suspension shall come to an end 28 days after the date of service of the opt out notice, or

(iii) the Department notifies the contractor after the end date that the Family Practitioner Services Independent Appeal Panel has not approved its proposed decision to refuse the contractor’s request to permanently opt out under sub-paragraph (14), in which case the suspension shall come to an end 28 days after the date of service of that notice.

(6) Before the end date, a Board may, in exceptional circumstances and with the agreement of the contractor, notify the contractor in writing of a later date on which the temporary opt out is to come to an end, being a date no more than six months later than the end date.

(7) Where the Board considers that –

(a) the contractor will be unable to satisfactorily provide the additional service at the end of the temporary opt out; and

(b) it would not be appropriate to exercise its discretion under sub-paragraph (6) to specify a later date on which the temporary opt out is to come to an end or the contractor does not agree to a later date,

the Board may notify the contractor in writing at least 28 days before the end date that a permanent opt out shall follow a temporary opt out.

(8) Where a Board notifies the contractor under sub-paragraph (7) that a permanent opt out shall follow a temporary opt out, the permanent opt out shall take effect immediately after the end of the temporary opt out.

(9) A contractor who has temporarily opted out may, at least three months prior to the end date, notify the Board in writing that he wishes to permanently opt out of the additional service in question.

(10) Where the contractor has notified the Board under sub-paragraph (9) that it wishes to permanently opt out, the temporary opt out shall be followed by a permanent opt out beginning on the day after the end date unless the Board refuses the contractor’s request to permanently opt out by giving a notice in writing to the contractor to this effect.

(11) The Department may only give a notice under sub-paragraph (10) with the approval of the Family Practitioner Services Independent Appeal Panel .

(12) Where the Department seeks the approval of the Family Practitioner Services Independent Appeal Panel to a proposed decision to refuse a permanent opt out, it shall notify the contractor of having done so.

(13) If the Family Practitioner Services Independent Appeal Panel has not reached a decision as to whether or not to approve the Department’s proposed decision to refuse a permanent opt out before the end date, the contractor’s obligation to provide the additional service shall remain suspended until the date specified in sub-paragraph (5)(d)(ii) or (iii) (whichever is applicable).

(14) Where after the end date the Family Practitioner Services Independent Appeal Panel notifies the Department that it does not approve the Department’s proposed decision to refuse a permanent opt out, the Department shall notify the contractor in writing of this fact as soon as is reasonably practicable.

(15) A temporary opt out or permanent opt out commences, and a temporary opt out ends at 8am on the relevant day unless –

(a) the day is a Saturday, Sunday or a public or local holiday agreed with the Board,

in which case the opt out shall take effect on the next working day at 8am; or

(b) the Board and the contractor agree a different time.

Permanent opt outs

3

(1) In this paragraph –

“A day” is the day specified by the contactor in his permanent opt out notice to a Board for the commencement of the permanent opt out;

“B day” is the day six months after the date of service of the permanent opt out notice; and

“C day” is the day nine months after the date of service of the permanent opt out notice.

(2) As soon as is reasonably practicable and in any event within the period of 28 days beginning with and including the date of receipt of a permanent opt out notice under paragraph 1(5) (or temporary opt out notice which is treated as a permanent opt out notice under paragraph 1(7), the Board shall –

(a) approve the opt out notice; or

(b) reject the opt out notice in accordance with sub-paragraph (3),

and shall notify the contractor of its decision as soon as possible, including reasons for its decision where its decision is to reject the opt out notice.

(3) A Board may reject the opt out notice on the ground that the contractor is providing an additional service to patients other than his registered patients or enhanced services.

(4) A contractor may not withdraw an opt out notice once it has been approved by the Board in accordance with sub-paragraph (2)(a) without the Board’s agreement.

(5) If the Board approves the opt out notice under sub-paragraph (2)(a), it shall use its reasonable endeavours to make arrangements for the contractor’s registered patients to receive the additional service from an alternative provider from A day.

(6) The contractor’s duty to provide the additional service shall terminate on A day unless the Board serves a notice under sub-paragraph (7) (extending A day to B day or C day).

(7) If the Board is not successful in finding an alternative provider to take on the provision of the additional service from A day, then it shall notify the contractor in writing of this fact no later than one month before A day, and –

(a) in a case where A day is three months after service of the opt out notice, the contractor shall continue to provide the additional service until B day unless at least one month before B day he receives a notice in writing from the Board under sub-paragraph (8) that despite using its reasonable endeavours, it has failed to find an alternative provider to take on the provision of the additional service from B day;

(b) in a case where A day is six months after the service of the opt out notice, the contractor shall continue to provide the additional service until C day unless at least one month before C day he receives a notice from the Department under sub-paragraph (11) that it has made an application to the Family Practitioner Services Independent Appeal Panel under sub-paragraph (10) seeking its approval to a decision to refuse a permanent opt out or to delay the commencement of a permanent opt out until after C day.

(8) Where in accordance with sub-paragraph (7)(a) the permanent opt out is to commence on B day and the Department , despite using its reasonable endeavours has failed to find an alternative provider to take on the provision of the additional service from that day, it shall notify the contractor in writing of this fact at least one month before B day, in which case the contractor shall continue to provide the additional service until C Day unless at least one month before C day he receives a notice from the Department under sub-paragraph (11) that it has applied to the Family Practitioner Services Independent Appeal Panel under sub-paragraph (10) seeking its approval to a decision to refuse a permanent opt out or to postpone the commencement of a permanent opt out until after C day.

(9) As soon as is reasonably practicable and in any event within 7 days of the Board serving a notice under sub-paragraph (8), the Board shall enter into discussions with the contractor concerning the support that the Board may give to the contractor or other changes which the Board or the contractor may make in relation to the provision of the additional service until C day.

(10) The Department may, if it considers that there are exceptional circumstances, make an application to the Family Practitioner Services Independent Appeal Panel for approval of a decision to –

(a) refuse a permanent opt out; or

(b) postpone the commencement of a permanent opt out until after C day.

(11) As soon as practicable after making an application under sub-paragraph (10) to the Family Practitioner Services Independent Appeal Panel , the Department shall notify the contractor in writing that it has made such an application.

(12) On receiving an application under sub-paragraph (10) for approval of a decision to refuse a permanent opt out, the Family Practitioner Services Independent Appeal Panel shall –

(a) approve the Department ’s application;

(b) reject the Department ’s application, but nonetheless recommend a different date for the commencement of the permanent opt out which may be later than C day; or

(13) On receiving an application under sub-paragraph (10) for approval of a decision to postpone the commencement of a permanent opt out until after C day the Family Practitioner Services Independent Appeal Panel shall –

(a) approve the Department ’s application;

(b) reject the Department ’s application, but nonetheless recommend –

(i) that the permanent opt out commence on an earlier date to that proposed by the Department in its application, or

(ii) that the permanent opt out be refused; or

(14) The Family Practitioner Services Independent Appeal Panel shall notify the Department and the contractor in writing of its decision under sub-paragraph (12) or (13) as soon as is practicable, including reasons for its decision.

(15) Where the Family Practitioner Services Independent Appeal Panel –

(a) approves a decision to refuse an opt out under sub-paragraph (12)(a); or

(b) recommends that a permanent opt out be refused under sub-paragraph (13)(b)(ii),

the Department shall notify the contractor in writing that the contractor may not opt out of the additional service.

(16) Where a Board notifies a contractor under sub-paragraph (15), the contractor may not serve a preliminary opt out notice in respect of that additional service for a period of 12 months beginning with the date of service of the Board’s notice under sub-paragraph (15) unless there has been a change in the circumstances of the contractor in relation to his ability to deliver services under the contract.

(17) Where the Family Practitioner Services Independent Appeal Panel –

(a) recommends a different date for the commencement of the permanent opt out under sub-paragraph (12)(b);

(b) approves a Department ’s application to postpone a permanent opt out under sub-paragraph (13)(a); or

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The Health and Personal Social Services (General Medical Services Contracts) Regulations (Northern Ireland) 2004

PART 1 — GENERAL

Citation and commencement

1

Interpretation

2

PART 2 — CONTRACTORS

Conditions: General

3

Conditions relating solely to medical practitioners

4

General condition relating to all contracts

5

Reasons

6

Appeal

7

Prescribed period under Article 15C(b)(iii) of the Order

8

PART 3 — PRE-CONTRACT DISPUTE RESOLUTION

Pre-contract disputes

9

PART 4 — HEALTH SERVICES BODY STATUS

Health services body status

10

PART 5 — CONTRACTS: REQUIRED TERMS

Parties to the contract

11

Health and social services contract

12

Contracts with individuals practising in partnership

13

Duration

14

Essential services

15

Additional services

16

Opt outs of additional and out of hours services

17

Services generally

18

19

20

Certificates

21

Finance

22

23

Fees and charges

24

Arrangements on termination

25

Other contractual terms

26

PART 6 — FUNCTIONS OF LOCAL MEDICAL COMMITTEES

27

PART 7 — TRANSITIONAL PROVISIONS

Commencement

28

Additional services

29

Out of hours services

30

31

32

SCHEDULE 1 — ADDITIONAL SERVICES

Additional services generally

1

Cervical screening

2

Contraceptive services

3

Vaccinations and immunisations

4

Childhood vaccinations and immunisations

5

Child health surveillance

6

Maternity medical services