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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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(18) Where the Family Practitioner Services Independent Appeal Panel rejects the Department ’s application under sub-paragraph (12)(c) or (13)(c), the Department shall notify the contractor in writing that there shall be a permanent opt out, and the permanent opt out shall commence on C day or 28 days after the date of service of the Department ’s notice, whichever is the later.

(19) If the Family Practitioner Services Independent Appeal Panel has not reached a decision on the Department ’s application under sub-paragraph (10) before C day, the contractor’s obligation to provide the additional service shall continue until a notice is served on the contractor by the Department under sub-paragraph (17) or (18).

(20) Nothing in sub-paragraphs (1) to (19) shall prevent the contractor and the Board from agreeing a different date for the termination of the contractor’s duty under the contract to provide the additional service and accordingly, varying the contract in accordance with paragraph 96(1) of Schedule 5.

(21) The permanent opt out takes effect at 08.00 on the relevant day unless the Board and the contractor agree a different day or time.

Out of hours opt outs where the opt out notice is served after 30th September 2004

4

(1) This paragraph applies where a contractor wishes to serve or serves an out of hours opt out notice after 30th September 2004.

(2) A contractor which wishes to terminate his obligation to provide out of hours services which was included in the contract pursuant to regulation 30 shall notify the Board in writing to that effect (“an out of hours opt out notice”).

(3) An out of hours opt out notice shall specify the date from which the contractor would like the opt out to take effect, which must be either three or six months after the date of service of the out of hours opt out notice.

(4) As soon as is reasonably practicable and in any event within 28 days of receiving the out of hours opt out notice, the Board shall approve the notice and specify in accordance with sub-paragraph (6) the date on which the out of hours opt out is to commence (“OOH day”).

(5) The Board shall notify the contractor of its decision as soon as possible including the reason for its decision.

(6) The date specified in sub-paragraph (4) shall be the date specified in the out of hours opt out notice.

(7) A contractor may not withdraw an out of hours opt out notice once it has been approved by the Board under sub-paragraph (4) without the Board’s agreement.

(8) Following receipt of the out of hours opt out notice, the Board must use its reasonable endeavours to make arrangements for the contractor’s registered patients to receive the out of hours services from an alternative provider from OOH day.

(9) Sub-paragraphs (6) to (21) of paragraph 3 shall apply to an out of hours opt out as they apply to a permanent opt out and as if the reference to “A day” was a reference to “OOH day” and the reference in paragraph 3(16) to a “preliminary opt out notice” was a reference to an out of hours opt out notice.

Out of hours opt outs where the opt out notice is served before 1st October 2004

5

(1) This paragraph shall apply where a contractor wishes to serve or serves an out of hours opt out notice before 1st October 2004.

(2) In this paragraph –

“OOH day” is the day specified by the Board for the commencement of the out of hours opt out in its decision under sub-paragraph (5);

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

“OOHC day” is the day specified by the Board in its decision under sub-paragraph (11) or (13) (which must be nine months after the date of service of the out of hours opt out notice or before 2nd January 2005).

(3) A contractor which wishes to terminate his obligation to provide out of hours services which was included in the contract pursuant to regulation 30 shall notify the relevant Board in writing to that effect (“an out of hours opt out notice”).

(4) An out of hours opt out notice shall state the date on which the contractor would like the opt out to take effect, which must be either three or six months after the date of service of the out of hours opt out notice.

(5) As soon as is reasonably practicable and in any event within 28 days of receiving the out of hours opt out notice, the Board shall approve the notice and specify in accordance with sub-paragraphs (6) and (7) the date on which the out of hours opt out is to commence (OOH day) and the Board shall notify the contractor in writing of its decision as soon as possible, including reasons for its decision.

(6) Subject to sub-paragraph (7), OOH day shall be –

(a) the date specified in the out of hours opt out notice; or

(b) any other date before 2nd January 2005.

(7) A Board may not specify under sub-paragraph (5) a date earlier than the date specified in the out of hours opt out notice.

(8) A contractor may not withdraw an out of hours opt out notice once it has been approved by a Board under sub-paragraph (5) without the Board’s agreement.

(9) Following receipt of the out of hours opt out notice, the Board must use its reasonable endeavours to make arrangements for the contractor’s registered patients to receive out of hours services from an alternative provider from OOH day.

(10) The contractor’s duty to provide the out of hours services shall terminate on OOH day unless the Department –

(a) serves a notice under sub-paragraph (11) (extending OOH day to OOHB day or OOHC day); or

(b) makes an application under sub-paragraph (14) (seeking the approval of the Family Practitioner Services Independent Appeal Panel to a decision to refuse an opt out or to delay the taking of effect of an opt out until after OOH day).

(11) If the Department is not successful in finding an alternative provider to take on the provision of the out hours services from OOH day, then it shall notify the contractor in writing of this fact no later than one month before OOH day, and –

(a) in a case where OOH day is three months after service of the out of hours opt out notice, the contractor shall continue to provide the out of hours services until OOHB day unless at least one month before OOHB day he receives a notice in writing from the Department under sub-paragraph (13) that despite using its reasonable endeavours, it has failed to find an alternative provider to take on the provision of the out of hours services from OOHB day;

(b) in a case where OOH day is after the day three months after the service of the out of hours opt out notice, the contractor shall continue to provide the out of hours services until OOHC day (which shall be specified by the Department in accordance with sub-paragraph (12) and included in its notice to the contractor under this sub-paragraph) unless at least one month before OOHC day he receives a notice from the Department under sub-paragraph (16) that it has made an application to the Family Practitioner Services Independent Appeal Panel under sub-paragraph (14) seeking the Family Practitioner Services Independent Appeal Panel ’s approval to a decision to refuse an opt out or to postpone the commencement of the opt out until after OOHC day.

(12) OOHC day shall be any day before 2nd January 2005 or the day nine months after the service of the out of hours opt out notice.

(13) Where in accordance with sub-paragraph (11)(a) the out of hours opt out is to commence on OOHB day and the Department , despite using its reasonable endeavours has failed to find an alternative provider to take on the provision of the out of hours services from that day, it shall notify the contractor in writing of this fact at least one month before OOHB day, in which case the contractor shall continue to provide the out of hours services until OOHC day (which shall be specified by the Department in accordance with sub-paragraph (12) and included in its notice to the contractor under this sub-paragraph) unless at least one month before OOHC day he receives a notice from the Department under sub-paragraph (16) that it has applied to the Family Practitioner Services Independent Appeal Panel under sub-paragraph (14) seeking the approval of the Family Practitioner Services Independent Appeal Panel to a decision to refuse an opt out or to postpone the commencement of an opt out until after OOHC day.

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

(a) refuse an opt out; or

(b) postpone the commencement of an opt out until after –

(i) OOHC day, or

(ii) OOH day where OOH day is 1st January 2005 and 1st January 2005 is nine months or more after the date of the out of hours opt out notice.

(15) Where OOH day is1st January 2005, and 1st January 2005 is nine months or more after the date of the out of hours opt out notice, an application under sub-paragraph (14) shall be made at least one month before OOH day.

(16) As soon as practicable after making an application under sub-paragraph (14) to the Family Practitioner Services Independent Appeal Panel , the Department shall notify the contractor in writing that it has made such an application.

(17) Sub-paragraphs (12) to (21) of paragraph 3 shall apply to an out of hours opt out as they apply to a permanent opt out and as if the reference to “C day” was a reference to OOHC day or OOH day where OOH day is 1st January 2005 and 1st January 2005 is nine months or more after the date of the out of hours opt out notice.

Informing patients of opt outs

6

(1) Prior to any opt out taking effect, the Board and the contractor shall discuss how to inform the contractor’s patients of the proposed opt out.

(2) The contractor shall, if requested by the Board inform his registered patients of an opt out and the arrangements made for them to receive the additional service or out of hours services by –

(a) placing a notice in the practice’s waiting room; or

(b) including the information in the practice leaflet.

(3) In this paragraph “opt out” means an out of hours opt out, a permanent opt out or a temporary opt out.

SCHEDULE 3 — LIST OF PRESCRIBED MEDICAL CERTIFICATES

1

To support a claim or to obtain payment either personally or by proxy; to prove inability to work or incapacity for self-support for the purposes of an award by the Department; or to enable proxy to draw pensions etc.

2

To establish pregnancy for the purpose of obtaining welfare foods

3

To secure registration of still-births.

4

To enable payment to be made to an institution or other person in case of mental disorder of persons entitled to payment from public funds.

5

To establish unfitness for jury service

6

To support late application for reinstatement in civil employment or notification of non-availability to take up employment owing to sickness.

7

To enable a person to be registered as an absent voter on grounds of physical incapacity

8

To support applications for certificates conferring exemption from charges in respect of drugs, medicines and appliances.

SCHEDULE 4 — FEES AND CHARGES

1

The contractor may demand or accept a fee or other remuneration –

(a) from any public body for services rendered for the purposes of that body’s statutory functions;

(b) from any body, employer or school for a routine medical examination of persons for whose welfare the body, employer or school is responsible, or an examination of such persons for the purpose of advising the body, employer or school of any administrative action they might take;

(c) for treatment which is not primary medical services or otherwise required to be provided under the contract and which is given:

(i) pursuant to the provisions of Article 31 of the Order (Accommodation and services for private patients), or

(ii) in a registered nursing home which is not providing services under that Order,

if, in either case, the person administering the treatment is serving on the staff of a hospital providing services under the Order as a specialist providing treatment of the kind the patient requires and if, within 7 days of giving the treatment, the contractor or the person providing the treatment supplies the Board, on a form provided by it for the purpose, with such information about the treatment as it may require;

(d) when he treats a patient under regulation 24(3), in which case he shall be entitled to demand and accept a reasonable fee (recoverable in certain circumstances under regulation 24(4)) for any treatment given, if he gives the patient a receipt;

(e) for attending and examining (but not otherwise treating) a patient –

(i) at his request at a police station in connection with possible criminal proceedings against him,

(ii) at the request of a commercial, educational or not-for-profit organisation for the purpose of creating a medical report or certificate,

(iii) for the purpose of creating a medical report required in connection with an actual or potential claim for compensation by the patient;

(f) for treatment consisting of an immunisation for which no remuneration is payable by the Board and which is requested in connection with travel abroad;

(g) for prescribing or providing drugs, medicines or appliances (including a collection of such drugs, medicines or appliances in the form of a travel kit) which a patient requires to have in his possession solely in anticipation of the onset of an ailment or occurrence of an injury while he is outside the United Kingdom but for which he is not requiring treatment when the medicine is prescribed;

(h) for a medical examination –

(i) to enable a decision to be made whether or not it is inadvisable on medical grounds for a person to wear a seat belt, or

(ii) for the purpose of creating a report –

(aa) relating to a road traffic accident or criminal assault, or

(bb) that offers an opinion as to whether a patient is fit to travel;

(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(j) where he is a contractor which is required by a Board under regulation 12 of the Pharmaceutical Regulations to provide drugs, medicines or appliances to a patient and provides for that patient, otherwise than under pharmaceutical services, any Scheduled drug;

(k) for prescribing or providing drugs or medicines for malaria chemoprophylaxis;

(l) when he treats a visiting patient under regulation 15(3) or (5), the contractor shall be entitled to demand and accept a fee as determined by the Department, if a receipt is provided to that patient and the contractor notifies the Board of the treatment provided;

(m) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SCHEDULE 5 — OTHER CONTRACTUAL TERMS

PART 1 — provision of services

Premises

1

Subject to any plan which is included in the contract pursuant to regulation 18(3), the contractor shall ensure that the premises used for the provision of services under the contract are –

(a) suitable for the delivery of those services; and

(b) sufficient to meet the reasonable needs of the contractor’s patients.

Attendance at practice premises

2

(1) The contractor shall take steps to ensure that any patient who –

(a) has not previously made an appointment; and

(b) attends at the practice premises during the normal hours for essential services,

is provided with such services by an appropriate health care professional during that surgery period except in the circumstances specified in sub-paragraph (2).

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

(a) it is more appropriate for the patient to be referred elsewhere for services under the Order; or

(b) the patient is then offered an appointment to attend again within a time which is appropriate and reasonable having regard to all the circumstances and the patient’s health would not thereby be jeopardised.

Attendance outside practice premises

3

(1) In the case of a patient whose medical condition is such that in the reasonable opinion of the contractor –

(a) attendance on the patient is required; and

(b) it would be inappropriate for the patient to attend at the practice premises,

the contractor shall provide services to that patient at whichever in his judgement is the most appropriate of the places set out in sub-paragraph (2).

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

(a) the place recorded in the patient’s medical records as being his last home address;

(b) such other place as the contractor has informed the patient and the Board is the place where he has agreed to visit and treat the patient; or

(3) Nothing in this paragraph prevents the contractor from –

(a) arranging for the referral of a patient without first seeing the patient, in a case where the medical condition of that patient makes that course of action appropriate; or

(b) visiting the patient in circumstances where this paragraph does not place him under an obligation to do so.

(4) Notwithstanding anything in this paragraph, the contractor shall not be required to attend on a patient ...outside Northern Ireland.

Newly registered patients

4

(1) Where a patient has been –

(a) accepted on a contractor’s list of patients under paragraph 15; or

(b) assigned to that list by the Board,

the contractor shall, in addition and without prejudice to his other obligations in respect of that patient under the contract, invite the patient to participate in a consultation either at his practice premises or, if the medical condition of the patient so warrants, at one of the places referred to in paragraph 3(2).

(2) An invitation under sub-paragraph (1) shall be issued within six months of the date of the acceptance of the patient on, or their assignment to, the contractor’s list.

(3) Where a patient (or, where appropriate, in the case of a patient who is a child, his parent) agrees to participate in a consultation mentioned in sub-paragraph (1) the contractor shall, in the course of that consultation make such inquiries and undertake such examinations as appear to him to be appropriate in all the circumstances.

Patients not seen within three years

5

Where a registered patient who –

(a) has attained the age of 16 years but has not attained the age of 75 years; and

(b) has attended neither a consultation with, nor a clinic provided by, the contractor within the period of 3 years prior to the date of his request;

requests a consultation the contractor shall, in addition and without prejudice to his other obligations in respect of that patient under the contract, provide such a consultation in the course of which it shall make such inquiries and undertake such examinations as appear to him to be appropriate in all the circumstances.

Patients aged 75 years and over

6

(1) Where a registered patient who –

(a) has attained the age of 75 years; and

(b) has not participated in a consultation under this paragraph within the period of twelve months prior to the date of his request,

requests a consultation, the contractor shall, in addition and without prejudice to his other obligations in respect of that patient under the contract, provide such a consultation in the course of which he shall make such inquiries and undertake such examinations as appear to him to be appropriate in all the circumstances.

(2) A consultation under sub-paragraph (1) shall take place in the home of the patient where, in the reasonable opinion of the contractor, it would be inappropriate, as a result of the patient’s medical condition, for him to attend at the practice premises.

Clinical reports

7

(1) Where the contractor provides any clinical services, other than under a private arrangement, to a patient who is not on his list of patients, he shall, as soon as reasonably practicable, provide a clinical report relating to the consultation, and any treatment provided, to the Board.

(2) The Board shall send any report received under sub-paragraph (1) –

(a) to the person with whom the patient is registered for the provision of essential services or their equivalent; or

(b) if the person referred to in head (a) is not known to it, to the Board in whose area the patient is resident.

(3) This paragraph does not apply in relation to out of hours services provided by a contractor on or after 1st May 2005.

Storage of vaccines

8

The contractor shall ensure that –

(a) all vaccines are stored in accordance with the manufacturer’s instructions,

(b) all refrigerators in which vaccines are stored have a maximum/minimum thermometer and that readings are taken on all working days.

Infection control

9

The contractor shall ensure that he has appropriate arrangements for infection control and decontamination.

Criteria for out of hours services

10

A contractor whose contract includes the provision of out of hours services shall only be required to provide such services if, in the reasonable opinion of the contractor in the light of the patient’s medical condition, it would not be reasonable in all the circumstances for the patient to wait for the services required until the next time at which he could obtain such services during core hours.

Standards for out of hours services

11

...a contractor which provides out of hours services must in the provision of such services meet any quality standards which have been approved by the Department and specified in writing by the Board in relation to the provision of those services.

Duty of co-operation in relation to additional, enhanced and out of hours services

12

(1) A contractor which does not provide to his registered patients or to persons whom he has accepted as temporary residents –

(a) a particular additional service;

(b) a particular enhanced service; or

shall comply with the requirements specified in sub-paragraph (2).

(2) The requirements referred to in sub-paragraph (1) are that the contractor shall –

(a) co-operate with any person responsible for the provision of that service;

(b) comply in core hours with any reasonable request for information from such a person or from the Board relating to the provision of that service or those services; and

(c) in the case of out of hours services, take reasonable steps to ensure that any patient who contacts the practice premises during the out of hours period is provided with information about how to obtain services during that period.

(3) Nothing in this paragraph shall require a contractor whose contract does not include the provision of out of hours services to make himself available during the out of hours period.

13

Where a contractor is to cease to be required to provide to his patients –

(a) a particular additional service;

(b) a particular enhanced service; or

he shall comply with any reasonable request for information relating to the provision of that service made by the Board or by any person with whom the Board intends to enter into a contract for the provision of such services.

PART 2 — patients

List of patients

14

The Board shall prepare and keep up to date a list of the patients –

(a) who have been accepted by the contractor for inclusion in his list of patients under paragraph 15 and who have not subsequently been removed from that list under paragraphs 19 to 27; and

(b) who have been assigned to the contractor under paragraph 32 or 33 and whose assignment has not subsequently been rescinded.

Application for inclusion in a list of patients

15

(1) The contractor may, if his list of patients is open, accept an application for inclusion in his list of patients made by or on behalf of any person whether or not resident in his practice area or included, at the time of that application, in the list of patients of another contractor or provider of primary medical services.

(2) The contractor may, if his list of patients is closed, only accept an application for inclusion in his list of patients from a person who is an immediate family member of a registered patient whether or not resident in his practice area or included, at the time of that application, in the list of patients of another contractor or provider of primary medical services.

(3) Subject to sub-paragraph (4), an application for inclusion in a contractor’s list of patients shall be made by delivering to the practice premises a medical card or an application signed (in either case) by the applicant or a person authorised by the applicant to sign on his behalf.

(4) An application may be made –

(a) on behalf of any child –

(i) by either parent, or in the absence of both parents, the guardian or other adult who has care of the child,

(ii) by a person duly authorised by an authority looking after a child under the provisions of the Children (Northern Ireland) Order 1995, or

(iii) by a person duly authorised by a voluntary organisation by which the child is being accommodated under the provisions of that Order; or

(b) on behalf of any adult who is incapable of making such an application, or authorising such an application to be made on their behalf, by a relative or the primary carer of that person.

(5) A contractor which accepts an application for inclusion in his list of patients shall notify the Board in writing as soon as possible.

(6) On receipt of a notice under sub-paragraph (5), the Board shall –

(a) include that person in the contractor’s list of patients from the date on which the notice is received; and

(b) notify the applicant (or, in the case of a child or incapable adult, the person making the application on their behalf) of the acceptance.

Temporary residents

16

(1) The contractor may, if his list of patients is open, accept a person who is ordinarily resident in Northern Ireland as a temporary resident provided he is satisfied that the person is –

(a) temporarily resident away from his normal place of residence and is not being provided with essential services (or their equivalent) under any other arrangement in the place where he is temporarily residing; or

(b) moving from place to place and not for the time being resident in any place.

(2) For the purposes of sub-paragraph (1), a person shall be regarded as temporarily resident in a place if, when he arrives in that place, he intends to stay there for more than 24 hours but not more than three months.

(3) A contractor which wishes to terminate his responsibility for a person accepted as a temporary resident before the end of –

(a) three months; or

(b) such shorter period for which he agreed to accept him as a patient,

shall notify him either orally or in writing and his responsibility for that patient shall cease 7 days after the date on which the notification was given.

(4) At the end of three months, or on such earlier date as his responsibility for the temporary resident has come to an end, the contractor shall notify the Board in writing of any person whom he accepted as a temporary resident.

Refusal of applications for inclusion in the list of patients or for acceptance as a temporary resident

17

(1) The contractor shall only refuse an application made under paragraph 15 , 15A, 15B or 16 if he has reasonable grounds for doing so which do not relate to the applicant’s race, gender, social class, marital status, age, religion, political opinion, sexual orientation, appearance, disability, medical condition or whether or not the applicant has dependants.

(2) The reasonable grounds referred to in paragraph (1) may, in the case of an application made under paragraph 15 or 15B , include the grounds that the applicant—

(a) does not live in the contractor’s practice area; or

(b) lives in the outer boundary area (the area referred to in paragraph 18(1A)).

(3) A contractor which refuses an application made under paragraph 15 , 15A, 15B or 16 shall, within 14 days of his decision, notify the applicant (or, in the case of a child or incapable adult, the person making the application on their behalf) in writing of the refusal and the reason for it.

(4) The contractor shall keep a written record of refusals of applications made under paragraph 15 , 15A and 15B and of the reasons for them and shall make this record available to the Board on request.

Patient preference of practitioner

18

(1) Where the contractor has accepted an application for inclusion in his list of patients, he shall –

(a) notify the patient (or, in the case of a child or incapable adult, the person who made the application on their behalf) of the patient’s right to express a preference to receive services from a particular performer or class of performer either generally or in relation to any particular condition; and

(b) record in writing any such preference expressed by or on behalf of the patient.

(2) The contractor shall endeavour to comply with any reasonable preference expressed under sub-paragraph (1) but need not do so if the preferred performer –

(a) has reasonable grounds for refusing to provide services to the patient; or

(b) does not routinely perform the service in question within the practice.

Removal from the list at the request of the patient

19

(1) The contractor shall notify the Board in writing of any request for removal from his list of patients received from a registered patient.

(2) Where the Board –

(a) receives notification from the contractor under sub-paragraph (1); or

(b) receives a request from the patient to be removed from the contractor’s list of patients,

it shall remove that person from the contractor’s list of patients.

(3) A removal in accordance with sub-paragraph (2) shall take effect –

(a) on the date on which the Board receives notification of the registration of the person with another provider of essential services (or their equivalent); or

(b) 14 days after the date on which the notification or request made under sub-paragraph (1) or (2) respectively is received by the Board,

whichever is the sooner.

(4) The Board shall, as soon as practicable, notify in writing –

(a) the patient; and

(b) the contractor,

that the patient’s name will be or has been removed from the contractor’s list of patients on the date referred to in sub-paragraph (3).

(5) In this paragraph and in paragraphs 20(1)(b) and (10), 21(6) and (7), 23 and 26, a reference to a request received from or advice, information or notification required to be given to a patient shall include a request received from or advice, information or notification required to be given to –

(a) in the case of a patient who is a child, a parent or other person referred to in paragraph 15(4)(a); or

(b) in the case of an adult patient who is incapable of making the relevant request or receiving the relevant advice, information or notification, a relative or the primary carer of the patient.

Removal from the list at the request of the patient

20

(1) Subject to paragraph 21, a contractor which has reasonable grounds for wishing a patient to be removed from his list of patients which do not relate to the patient’s race, gender, social class, marital status, age, religion, political opinion, sexual orientation, appearance, disability, medical condition, or whether or not the patient has dependants shall –

(a) notify the Board in writing that he wishes to have the patient removed; and

(b) subject to sub-paragraph (2), notify the patient of his specific reasons for requesting removal.

(2) Where in the reasonable opinion of the contractor –

(a) the circumstances of the removal are such that it is not appropriate for a more specific reason to be given; and

(b) there has been an irrevocable breakdown in the relationship between the patient and the contractor,

the reason given under sub-paragraph (1) may consist of a statement that there has been such a breakdown.

(3) Except in the circumstances specified in sub-paragraph (4), a contractor may only request a removal under sub-paragraph (1), if, within the period of 12 months prior to the date of his request to the Board, he has warned the patient that he is at risk of removal and explained to him the reasons for this.

(4) The circumstances referred to in sub-paragraph (3) are that –

(a) the reason for removal relates to a change of address;

(b) the contractor has reasonable grounds for believing that the issue of such a warning would –

(i) be harmful to the physical or mental health of the patient, or

(ii) put at risk the safety of one or more of the persons specified in sub-paragraph (5); or

(5) The persons referred to in sub-paragraph (4) are –

(a) the contractor, where he is an individual medical practitioner;

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

(d) a member of the contractor’s staff;

(e) a person engaged by the contractor to perform or assist in the performance of services under the contract; or

(f) any other person present –

(i) on the practice premises, or

(ii) in the place where services are being provided to the patient under the contract.

(6) The contractor shall record in writing –

(a) the date of any warning given in accordance with sub-paragraph (3) and the reasons for giving such a warning as explained to the patient; or

(b) the reason why no such warning was given.

(7) The contractor shall keep a written record of removals under this paragraph which shall include –

(a) the reason for removal given to the patient;

(b) the circumstances of the removal; and

and shall make this record available to the Board on request.

(8) A removal requested in accordance with sub-paragraph (1) shall, subject to sub-paragraph (9), take effect from –

(a) the date on which the Board receives notification of the registration of the person with another provider of essential services (or their equivalent); or

(b) the eighth day after the Board receives the notice referred to in sub-paragraph (1)(a),

whichever is the sooner.

(9) Where, on the date on which the removal would take effect under sub-paragraph (8), the contractor is treating the patient at intervals of less than seven days, the contractor shall notify the Board in writing of the fact and the removal shall take effect –

(a) on the eighth day after the Board receives notification from the contractor that the person no longer needs such treatment; or

(b) on the date on which the Board receives notification of the registration of the person with another provider of essential services (or their equivalent),

whichever is the sooner.

(10) The Board shall notify in writing –

(a) the patient; and

(b) the contractor,

that the patient’s name has been or will be removed from the contractor’s list of patients on the date referred to in sub-paragraph (8) or (9).

Removals from the list of patients who are violent

21

(1) A contractor which wishes a patient to be removed from his list of patients with immediate effect on the grounds that –

(a) the patient has committed an act of violence against any of the persons specified in sub-paragraph (2) or behaved in such a way that any such person has feared for his safety; and

(b) he has reported the incident to the police,

shall notify the Board in accordance with sub-paragraph (3).

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

(a) the contractor where he is a medical practitioner;

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

(d) a member of the contractor’s staff;

(e) a person engaged by the contractor to perform or assist in the performance of services under the contract; or

(f) any other person present –

(i) on the practice premises, or

(ii) in the place where services were provided to the patient under contract.

(3) Notification under sub-paragraph (1) may be given by any means including telephone or fax but if not given in writing shall subsequently be confirmed in writing within seven days (and for this purpose a faxed notification is not a written one).

(4) The Board shall acknowledge in writing receipt of a request from the contractor under sub-paragraph (1).

(5) A removal requested in accordance with sub-paragraph (1) shall take effect at the time that the contractor –

(a) makes the telephone call to the Board; or

(b) sends or delivers the notification to the Board.

(6) Where, pursuant to this paragraph, ... he has notified the Board that he wishes to have a patient removed from his list of patients, it shall inform the patient concerned unless –

(a) it is not reasonably practicable for ... him to do so; or

(b) ... he has reasonable grounds for believing that to do so would –

(i) be harmful to the physical or mental health of the patient; or

(ii) put at risk the safety of one or more of the persons specified in sub-paragraph (2).

(7) Where the Board has removed a patient from the contractor’s list of patients in accordance with sub-paragraph (5), it shall give written notice of the removal to that patient.

(8) Where a patient is removed from the contractor’s list of patients in accordance with this paragraph, the contractor shall record in the patient’s medical records that the patient has been removed under this paragraph and the circumstances leading to his removal.

Removals from the list of patients registered elsewhere

22

(1) The Board shall remove a patient from the contractor’s list of patients if –

(a) the patient has subsequently been registered with another provider of essential services (or their equivalent) in the area of the Board; or

(b) it has received notice from another Board, NHS England , a Local Health Board or a Health Board that the patient has subsequently been registered with a provider of essential services (or their equivalent) outside the area of the Board.

(2) A removal in accordance with sub-paragraph (1) shall take effect –

(a) on the date on which the Board receives notification of the registration of the person with the new provider; or

(b) with the consent of the Board, on such other date as has been agreed between the contractor and the new provider.

(3) The Board shall notify the contractor in writing of persons removed from his list of patients under sub-paragraph (1).

Removals from the list of patients who have moved

23

(1) Subject to sub-paragraph (2), where the Board is satisfied that a person on the contractor’s list of patients has moved and no longer resides in that contractor’s practice area, the Board shall –

(a) inform that patient and the contractor that the contractor is no longer obliged to visit and treat the person;

(b) advise the patient in writing either to obtain the contractor’s agreement to the continued inclusion of the person on his list of patients or to apply for registration with another provider of essential services (or their equivalent); and

(c) inform the patient that if, after the expiration of 30 days from and including the date of the advice mentioned in paragraph (b), he has not acted in accordance with the advice and informed it accordingly, the Board will remove him from the contractor’s list of patients.

(2) If, at the expiration of the period of 30 days referred to in sub-paragraph (1)(c), the Board has not been notified of the action taken, it shall remove the patient from the contractor’s list of patients and inform him and the contractor accordingly.

24

Where the address of a patient who is on the contractor’s list of patients is no longer known to the Board, the Board shall –

(a) give to the contractor notice in writing that it intends, at the end of the period of six months commencing with the date of the notice, to remove the patient from the contractor’s list of patients; and

(b) at the end of that period, remove the patient from the contractor’s list of patients unless, within that period, the contractor satisfies the Board that he is still responsible for providing essential services to that patient.

Removals from the list of patients absent from the United Kingdom etc.

25

(1) The Board shall remove a patient from the contractor’s list of patients where it receives notification that that patient –

(a) intends to be away from the United Kingdom for a period of at least three months;

(b) is in Her Majesty’s Forces;

(d) has been absent from the United Kingdom for a period of more than three months; or

(e) has died.

(2) A removal in accordance with sub-paragraph (1) shall take effect –

(a) in the cases referred to in sub-paragraph (1)(a) to (c) from the date of the departure, enlistment or imprisonment or the date on which the Board first receives notification of the departure, enlistment or imprisonment whichever is the later; or

(b) in the cases referred to in sub-paragraph (1)(d) and (e) from the date on which the Board first receives notification of the absence or death.

(3) The Board shall notify the contractor in writing of patients removed from his list of patients under sub-paragraph (1).

Removals from the list of patients accepted elsewhere as temporary residents

26

(1) The Board shall remove from the contractor’s list of patients a patient who has been accepted as a temporary resident by another contractor or other provider of essential services (or their equivalent) where it is satisfied, after due inquiry –

(a) that the patient’s stay in the place of temporary residence has exceeded three months; and

(b) that he has not returned to his normal place of residence or any other place within the contractor’s practice area.

(2) The Board shall notify in writing of a removal under sub-paragraph (1) –

(a) the contractor; and

(b) where practicable, the patient.

(3) A notification to the patient under sub-paragraph (2)(b) shall inform him of –

(a) his entitlement to make arrangements for the provision to him of essential services (or their equivalent), including by the contractor by which he has been treated as a temporary resident; and

(b) the name and address of the Board in whose area he is resident.

Removals from the list of pupils etc. of a school

27

(1) Where the contractor provides essential services under the contract to persons on the grounds that they are pupils at or staff or residents of a school, the Board shall remove from the contractor’s list of patients any such persons who do not appear on particulars of persons who are pupils at or staff or residents of that school provided by that school.

(2) Where the Board has made a request to a school to provide the particulars mentioned in sub-paragraph (1) and has not received them, it shall consult the contractor as to whether it should remove from his list of patients any persons appearing on that list as pupils at, or staff or residents of, that school.

(3) The Board shall notify the contractor in writing of patients removed from his list of patients under sub-paragraph (1).

Termination of responsibility for patients not registered with the contractor

28

(1) Where a contractor –

(a) has received an application for the provision of medical services other than essential services –

(i) from a person who is not included in his list of patients,

(ii) from a person whom he has not accepted as a temporary resident, or

(iii) on behalf of a person mentioned in head (a)(i) or (ii), from one of the persons specified in paragraph 15(4); and

(b) has accepted that person as a patient for the provision of the service in question,

his responsibility for that patient shall be terminated in the circumstances referred to in sub-paragraph (2).

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

(a) the patient informs the contractor that he no longer wishes him to be responsible for provision of the service in question;

(b) in cases where the contractor has reasonable grounds for terminating his responsibility which do not relate to the person’s race, gender, social class, marital status, age, religion, political opinion, sexual orientation, appearance, disability, medical condition or whether or not the patient has dependants, the contractor informs the patient that he no longer wishes to be responsible for providing him with the service in question; or

(i) no longer resides in the area for which the contractor has agreed to provide the service in question; or

(ii) is no longer included in the list of patients of an other contractor to whose registered patients the contractor has agreed to provide that service.

(3) A contractor which wishes to terminate his responsibility for a patient under sub-paragraph (2)(b) shall notify the patient of the termination and the reason for it.

(4) The contractor shall keep a written record of terminations under this paragraph and of the reasons for them and shall make this record available to the Board on request.

(5) A termination under sub-paragraph (2)(b) shall take effect –

(a) from the date on which the notice is given where the grounds for termination are those specified in paragraph 21(1); or

(b) in all other cases, 14 days from the date on which the notice is given.

Closure of lists of patients

29

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Approval of closure notice by the Board

30

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rejection of closure notice by the Board

31

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Assignment of patients to lists: open lists

32

(1) A Board may, subject to paragraph 34, assign a new patient to a contractor whose list of patients is open.

(2) In this paragraph and in paragraphs 33 and 35 to 37, a “new” patient means a person who –

(a) is resident (whether or not temporarily) within the area of the Board;

(b) has been refused inclusion in a list of patients of, or has not been accepted as a temporary resident by, a contractor whose premises are within such an area; and

Assignment of patients to lists: closed lists

33

(1) A Board may not assign a new patient to a contractor which has closed his list of patients except in the circumstances specified in sub-paragraph (2).

(2) A Board may, subject to paragraph 34, assign a new patient to a contractor whose practice premises are within the Board’s area and which has closed his list of patients, if –

(a) most or all of the providers of essential services (or their equivalent) whose practice premises are within the Board’s area have closed their lists of patients;

(b) the assessment panel has determined under paragraph 35(7) that patients may be assigned to the contractor in question, and that determination has not been overturned either by a determination of the Department under paragraph 36(13) or (where applicable) by a court; and

(c) the Board has entered into discussions with the contractor in question regarding the assignment of a patient if such discussions are required under paragraph 37.

Factors relevant to assignments

34

In making an assignment to a contractor under paragraph 32 or 33, the Board shall have regard to –

(a) the wishes and circumstances of the patient to be assigned;

(b) the distance between the patient’s place of residence and the contractor’s practice premises;

(c) whether, during the six months ending on the date on which the application for assignment is received by the Board, the patient’s name has been removed from the list of patients of any contractor in the area of the Board under paragraph 20 or its equivalent provision in relation to an Article 15B provider in the area of the Board;

(d) whether the patient’s name has been removed from the list of patients of any contractor in the area of the Board under paragraph 21 or its equivalent provision in relation to an Article 15B provider in the area of the Board and, if so, whether the contractor has appropriate facilities to deal with such a patient;

(e) such other matters as the Board considers to be relevant.

Assignments to closed lists: determinations of the assessment panel

35

(1) This paragraph applies where most or all of the providers of essential services whose practice premises are within a Local Medical Committee area have closed their lists of patients.

(2) If the Board wishes to assign new patients to contractors which have closed their lists of patients, it must prepare a proposal to be considered by the assessment panel which must include details of those contractors to which the Board wishes to assign patients.

(3) The Board must ensure that the assessment panel is appointed to consider and determine its proposal made under sub-paragraph (2), and the composition of the assessment panel shall be as described in sub-paragraph (3A).

(3A) The members of the assessment panel must be—

(a) The Chief Executive of the Board;

(b) a person representative of patients in an area other than that of the contractor which is party to the contract;

(c) a person representative of a Local Medical Committee which does not represent practitioners in the Local Medical Committee area of the contractor which is a party to the contract”.

Assignments to closed lists: dispute resolution procedure relating to determinations of the assessment panel

36

(1) Where an assessment panel makes a determination under paragraph 35(7) that the Department may assign new patients to contractors which have closed their lists of patients, any contractor specified in that determination may refer the matter to the Family Practitioner Services Independent Appeal Panel to review the determination of the assessment panel.

(2) Where a matter is referred to the Family Practitioner Services Independent Appeal Panel in accordance with sub-paragraph (1), it shall be reviewed in accordance with the procedure specified in the following sub-paragraphs.

(3) Where more than one contractor specified in the determination in accordance with paragraph 35(7) wishes to refer the matter for dispute resolution, those contractors may, if they all agree, refer the matter jointly, and in that case the Family Practitioner Services Independent Appeal Panel shall review the matter in relation to those contractors together.

(4) Within the period of 7 days beginning with and including the date of the determination by the assessment panel in accordance with paragraph 35(7), the contractor shall send to the Family Practitioner Services Independent Appeal Panel a written request for dispute resolution which shall include or be accompanied by –

(a) the names and addresses of the parties to the dispute;

(b) a copy of the contract (or contracts); and

(5) Within the period of 7 days beginning with and including the date on which the matter was referred to it, the Family Practitioner Services Independent Appeal Panel shall –

(a) give to the parties notice in writing that it is dealing with the matter; and

(b) include with the notice a written request to the parties to make in writing within a specified period any representations which they may wish to make about the dispute.

(6) The Family Practitioner Services Independent Appeal Panel shall give, with the notice given under sub-paragraph (5), to the party, other than the one which referred the matter to dispute resolution, a copy of any document by which the dispute was referred to dispute resolution.

(7) The Family Practitioner Services Independent Appeal Panel shall, upon receiving any representations from a party, give a copy of them to the other party, and shall in each case request (in writing) a party to which a copy of the representations is given to make within a specified period any written observations which it wishes to make on those representations.

(8) For the purpose of assisting it in its consideration of the matter, the Family Practitioner Services Independent Appeal Panel may –

(a) invite representatives of the parties to appear before it to make oral representations either together or, with the agreement of the parties, separately, and may in advance provide the parties with a list of matters or questions to which it wishes them to give special consideration; or

(b) consult other persons whose expertise it considers will assist it in its consideration of the dispute.

(9) Where the Family Practitioner Services Independent Appeal Panel consults another person under sub-paragraph (8)(b), it shall notify the parties accordingly in writing and, where it considers that the interests of any party might be substantially affected by the result of the consultation, it shall give to the parties such opportunity as it considers reasonable in the circumstances to make observations on those results.

(10) In considering the dispute, the Family Practitioner Services Independent Appeal Panel shall consider –

(a) any written representations made in response to a request under sub-paragraph (5)(b), but only if they are made within the specified period;

(b) any written observations made in response to a request under sub-paragraph (7), but only if they are made within the specified period;

(d) the results of any consultation under sub-paragraph (8)(b); and

(e) any observations made in accordance with an opportunity given under sub-paragraph (9).

(11) Subject to the other provisions of this paragraph and to any agreement by the parties, the Family Practitioner Services Independent Appeal Panel shall have wide discretion in determining the procedure of the dispute resolution to ensure the just, expeditious, economical and final determination of the dispute.

(12) In this paragraph, “specified period” means such period as the Family Practitioner Services Independent Appeal Panel shall specify in the request, being not less than one, nor more than two, weeks beginning with and including the date on which the notice referred to is given, but the Family Practitioner Services Independent Appeal Panel may, if the period for determination of the dispute has been extended in accordance with sub-paragraph (16), extend any such period (even after it has expired) and, where it does so, a reference in this paragraph to the specified period is to the period as so extended.

(13) Subject to sub-paragraph (16), within the period of 21 days beginning with and including the date on which the matter was referred to it, the Family Practitioner Services Independent Appeal Panel shall determine whether the Department may assign patients to contractors which have closed their lists of patients; and if it determines that the Department may make such assignments, it shall also determine those contractors to which patients may be assigned.

(14) The Family Practitioner Services Independent Appeal Panel may not determine that patients may be assigned to a contractor which was not specified in the determination of the assessment panel under paragraph 35(7).

(15) In the case of a matter referred jointly by contractors in accordance with sub-paragraph (3), the Family Practitioner Services Independent Appeal Panel may determine that patients may be assigned to one, some or all of the contractors which referred the matter.

(16) The period of 21 days referred to in sub-paragraph (13) may be extended (even after it has expired) by a further specified number of days if an agreement to that effect is reached by –

(a) the Family Practitioner Services Independent Appeal Panel ;

(b) the Department ; and

(17) The Family Practitioner Services Independent Appeal Panel shall record its determination, and the reasons for it, in writing and shall give notice of the determination (including the record of the reasons) to the parties.

Assignments to closed lists: assignments of patients by a Board

37

(1) Before the Board may assign a new patient to a contractor, it shall, subject to sub-paragraph (3), enter into discussions with that contractor regarding additional support that the Board can offer the contractor, and the Board shall use its best endeavours to provide appropriate support.

(2) In the discussions referred to in sub-paragraph (1), both parties shall use reasonable endeavours to reach agreement.

(3) The requirement in sub-paragraph (1) to enter into discussions applies –

(a) to the first assignment of a patient to a particular contractor; and

(b) to any subsequent assignment to that contractor to the extent that it is reasonable and appropriate having regard to the numbers of patients who have been or may be assigned to him and the period of time since the last discussions under sub-paragraph (1) took place.

PART 3 — prescribing and dispensing

Prescribing

38

The contractor shall ensure that any prescription form or repeatable prescription for drugs, medicines or appliances issued by a prescriber complies as appropriate with the requirements in paragraphs 39 to 44 .

39

(1) Subject to paragraphs 40 and 41, a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract by issuing to that patient a prescription form and such a prescription form shall not be used in any other circumstances.

(2) In issuing any such prescription form the prescriber shall himself sign the prescription form in ink with his initials, or forenames, and surname in his own handwriting and not by means of a stamp and shall so sign only after particulars of the order have been inserted in the prescription form, and –

(a) the prescription form shall not refer to any previous prescription form; and

(b) a separate prescription form shall be used for each patient.

(3) Where a prescriber orders the drug buprenorphine or diazepam or a drug specified in Schedule 2 to the Misuse of Drugs Regulations (Northern Ireland) 2002 (controlled drugs to which regulations 14, 15, 16, 18, 19, 20, 21, 23, 26 and 27 of those Regulations apply)[^f00069] for supply by instalments for treating addiction to any drug specified in that Schedule, he shall –

(a) specify the number of instalments to be dispensed and the interval between each instalment; and

(b) order only such quantity of the drug as will provide treatment for a period not exceeding 14 days.

(4) In a case of urgency a prescriber may request a chemist to dispense a drug or medicine before a prescription form is issued, only if –

(a) that drug or medicine is not a Scheduled drug;

(b) that drug is not a controlled drug within the meaning of the Misuse of Drugs Act 1971[^f00070], other than a drug which is for the time being specified in Schedules 4 or 5 to the Misuse of Drugs Regulations (Northern Ireland) 2002[^f00071]; and

(c) he undertakes to furnish the chemist, within 72 hours, with a prescription form completed in accordance with sub-paragraph (3).

(5) In a case of urgency a prescriber may request a chemist to dispense an appliance before a prescription form is issued only if –

(a) that appliance does not contain a Scheduled drug or a controlled drug within the meaning of the Misuse of Drugs Act 1971, other than a drug which is for the time being specified in Schedule 5 to the Misuse of Drugs Regulations (Northern Ireland) 2002;

(b) in the case of a restricted availability appliance, the patient is a person, or it is for a purpose, specified in the Drug Tariff; and

(c) he undertakes to furnish the chemist, within 72 hours, with a prescription form completed in accordance with sub-paragraph (3).

Restrictions on prescribing by medical practitioners

40

(1) In the course of treating a patient to whom he is providing treatment under the contract, a medical practitioner shall not order on a prescription form a drug, medicine or other substance specified in any directions given by the Department under Article 57D of the Order[^f00072] as being drugs, medicines or other substances which may not be ordered for patients in the provision of medical services under the contract but may, subject to regulation 24(2)(b), prescribe such a drug, medicine or other substance for that patient in the course of that treatment under a private arrangement.

(2) In the course of treating a patient to whom he is providing treatment under the contract, a medical practitioner shall not order on a prescription form a drug, medicine or other substance 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 unless –

(a) that patient is a person of the specified description;

(b) that drug, medicine or other substance is prescribed for that patient only for the specified purpose; and

but may, subject to regulation 24(2)(b), prescribe such a drug, medicine or other substance for that patient in the course of that treatment under a private arrangement.

(3) In the course of treating a patient to whom he is providing treatment under the contract, a medical practitioner shall not order on a prescription form a restricted availability appliance unless –

(a) the patient is a person, or it is for a purpose, specified in the Drug Tariff; and

(b) the practitioner endorses the face of the form with the reference “SL2”,

but may, subject to regulation 24(2)(b), prescribe such an appliance for that patient in the course of that treatment under a private arrangement.

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

Restrictions on prescribing by supplementary prescribers

41

(1) The contractor shall have arrangements in place to secure that a supplementary prescriber will –

(a) give a prescription for a prescription only medicine;

(b) administer a prescription only medicine for parenteral administration; or

as a supplementary prescriber only under the conditions set out in sub-paragraph (2).

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

(a) the person satisfies the applicable conditions set out in regulation 215 of the Human Medicines Regulations 2012 (prescribing and administration by supplementary prescribers), unless those conditions do not apply by virtue of any of the exemptions set out in the subsequent provisions of those Regulations ;

(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c) the drug, medicine or other substance is not specified in any directions given by the Department under Article 57D of the Order[^f00074] as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract;

(d) the drug, medicine or other substance is not 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 unless –

(i) the patient is a person of the specified description,

(ii) the medicine is prescribed for that patient only for the specified purposes, and

(iii) if a supplementary prescriber is giving a prescription, he endorses the face of the form with the reference “SL2”.

(e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3) Where the functions of a supplementary prescriber include prescribing, the contractor shall have arrangements in place to secure that that person will only give a prescription for –

(a) an appliance; or

(b) a medicine which is not a prescription only medicine,

as a supplementary prescriber under the conditions set out in sub-paragraph (4).

(4) The conditions referred to in sub-paragraph (3) are that –

(a) the supplementary prescriber acts in accordance with a clinical management plan which is in effect at the time he acts and which contains the following particulars –

(i) the name of the patient to whom the plan relates,

(ii) the illness or conditions which may be treated by the supplementary prescriber,

(iii) the date on which the plan is to take effect, and when it is to be reviewed by the medical practitioner or dentist who is a party to the plan,

(iv) reference to the class or description of medicines or types of appliances which may be prescribed or administered under the plan,

(v) any restrictions or limitations as to the strength or dose of any medicine which may be prescribed or administered under the plan, and any period of administration or use of any medicine or appliance which may be prescribed or administered under the plan,

(vi) relevant warnings about known sensitivities of the patient to, or known difficulties of the patient with, particular medicines or appliances,

(vii) the arrangements for notification of –

(aa) suspected or known adverse reactions to any medicine which may be prescribed or administered under the plan, and suspected or known adverse reactions to any other medicine taken at the same time as any medicine prescribed or administered under the plan,

(bb) incidents occurring with the appliance which might lead, might have led or has led to the death or serious deterioration of state of health of the patient, and

(viii) the circumstances in which the supplementary prescriber should refer to, or seek the advice of, the medical practitioner or dentist who is a party to the plan;

(b) he has access to the health records of the patient to whom the plan relates which are used by any medical practitioner or dentist who is a party to the plan;

(d) if it is a prescription for a drug, medicine or other substance, that drug, medicine or other substance is not specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract;

(e) if it is a prescription for a drug, medicine or other substance, that drug, medicine or other substance is not 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 unless –

(i) the patient is a person of the specified description,

(ii) the medicine is prescribed for that patient only for the specified purposes, and

(iii) when giving the prescription, he endorses the face of the form with the reference “SL2”;

(f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(g) if it is a prescription for an appliance, the appliance is listed in Part IX of the Drug Tariff; and

(h) if it is a prescription for a restricted availability appliance –

(i) the patient is a person of a description mentioned in the entry in Part IX of the Drug Tariff in respect of that appliance,

(ii) the appliance is prescribed only for the purposes specified in respect of that person in that entry, and

(iii) when giving the prescription, he endorses the face of the form with the reference “SL2”.

(i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(5) In sub-paragraph (4)(a), “clinical management plan” means a written plan (which may be amended from time to time) relating to the treatment of an individual patient agreed by –

(a) the patient to whom the plan relates;

(b) the medical practitioner or dentist who is a party to the plan; and

(6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Interpretation of paragraphs 38, 39, 40 and 41

42

For the purposes of paragraphs 38, 39, 40 and 41 in their application to a contractor whose contract includes the provision of contraceptive services, drugs includes contraceptive substances and appliances includes contraceptive appliances.

Excessive prescribing

43

(1) The contractor shall not prescribe drugs, medicines or appliances whose cost or quantity, in relation to any patient, is, by reason of the character of the drug, medicine or appliance in question in excess of that which was reasonably necessary for the proper treatment of that patient.

(2) In considering whether a contractor has breached his obligations under sub-paragraph (1), the Board shall seek the views of the Local Medical Committee (if any) for its area.

Provision of dispensing services

44

(1) Without prejudice to any separate right a medical practitioner may have under regulation 12 of the Pharmaceutical Regulations (arrangements for provision of pharmaceutical services by doctors)[^f00078], a contractor may provide dispensing services to his registered patients under the contract only if he is required to do so by the Board in accordance with the following provisions of this paragraph.

(2) A contractor may provide dispensing services to his registered patients only if he is required to do so by the Board in accordance with the following provisions of this paragraph.

(3) Where the Board, is satisfied that a person, by reason of –

(a) distance;

(b) inadequacy of means of communication; or

will have serious difficulty in obtaining from a chemist any drugs, medicines or appliances, other than scheduled drugs, required for that person’s treatment, the Board shall require the contractor with whom the person is a registered patient to supply such drugs, medicines and appliances to that person until further notice.

(4) Notwithstanding anything contained in sub-paragraph (3) –

(a) a contractor shall not be required to undertake the supply of drugs, medicines and appliances under sub-paragraph (3) if the contractor satisfies the Board that the contractor does not normally provide dispensing services under the contract;

(b) a contractor shall be entitled to receive reasonable notice from the Board that the contractor is required to undertake the supply of drugs, medicines and appliances under sub-paragraph (2) or that such supply is to be discontinued.

(5) A contractor which is required under this paragraph to provide dispensing services to some or all of his registered patients may provide any necessary dispensing services to a person whom that contractor has accepted as a temporary resident.

Terms relating to the provision of dispensing services

45

(1) A contractor which has been required to secure the provision of dispensing services under paragraph 44 shall ensure that dispensing services are provided in accordance with the following sub-paragraphs.

(2) Subject to sub-paragraphs (3) and (4), a contractor providing dispensing services shall –

(a) record an order for the provision of any drugs, medicines or appliances which are needed for the treatment of the patient on a prescription form completed in accordance with paragraph 39(3);

(b) provide those drugs, medicines or appliances in a suitable container;

(c) provide for the patient a drug or medicine specified in any directions given by the Department under Article 57D of the Order[^f00079] as being a drug or medicine which can only be ordered for specified patients and specified purposes only if –

(i) that patient is a person of the specified description, and

(ii) the drug or medicine is supplied for that patient only for the specified purpose; and

(d) provide for the patient a restricted availability appliance only if the patient is a person, or it is for a purpose, specified in the Drug Tariff.

(3) Sub-paragraph (2) does not apply to drugs, medicines or appliances ordered on a prescription form by an independent prescriber or a supplementary prescriber .

(4) Where a patient presents an order on a prescription form for drugs, medicines or appliances signed by an independent prescriber or a supplementary prescriber , or an order for a restricted availability appliance signed by and endorsed on its face with the reference “SL2” by an independent prescriber or a supplementary prescriber , to a contractor who may provide dispensing services, the contractor may provide to the patient such of the drugs, medicines or appliances so ordered as he supplies in the normal course of his practice.

(5) Drugs, medicines or appliances provided under sub-paragraph (4) shall be provided in a suitable container.

(6) A contractor providing dispensing services shall not provide for a patient a drug or medicine specified in any directions given by the Department under Article 57D of the Order as being drugs or medicines which may not be ordered for patients in the provision of medical services under the contract, except that, where it has ordered a drug or medicine which has an appropriate non-proprietary name either by the name or by its formula, it may provide a drug or medicine which has the same specification notwithstanding that it is a drug or medicine specified in such directions (but, in the case of a drug or medicine which combines more than one drug, only if the combination has an appropriate non-proprietary name).

(7) Subject to sub-paragraph (9), nothing in this paragraph shall prevent a contractor providing a Scheduled drug or a restricted availability appliance in the course of treating a patient under a private arrangement.

(8) A contractor providing dispensing services shall comply with paragraph 14A of Schedule 2 to the Pharmaceutical Regulations, as if modified as follows –

(a) for “paragraph 13(a)”, substitute “sub-paragraph (2)(a) of paragraph 45 of Schedule 5 to the GMS Regulations ”;

(b) for “paragraph 11A(2)”, substitute “sub-paragraph (4) of that paragraph ”;

(c) for “a doctor who is required by the Board under regulation 12 to provide drugs and appliances to a patient”, substitute “a contractor providing dispensing services to a patient”; and

(d) for “doctor”, substitute “ contractor ”.

(9) The provisions of regulation 24 (fees and charges) apply in respect of the provision of any drugs, medicines or appliances by a contractor providing dispensing services as they apply in respect of prescriptions for drugs, medicines or appliances.

(10) A contractor who is entitled to provide dispensing services may, with the consent of the patient, order a drug, medicine or appliance for a patient on a prescription form, rather than providing it himself.

Dispensing contractor list

46

(1) Where the contractor is required by the Board under paragraph 44 to provide dispensing services to his patients and is actually doing so, the Board shall include –

(a) the contractor’s name; and

(b) the address of the practice premises from which he is required to dispense,

on a list of such contractors (to be called the dispensing contractors list) which it shall prepare, maintain and publish.

(2) The Board shall remove the name of the contractor from the list referred to in sub-paragraph (1) where the contractor ceases to provide dispensing services to his patients.

Provision of drugs, medicines and appliances for immediate treatment or personal administration

47

(1) Subject to sub-paragraph (2), a contractor –

(a) shall provide to a patient any drug, medicine or appliance, not being a Scheduled drug, where such provision is needed for the immediate treatment of that patient before a provision can otherwise be obtained; and

(b) may provide to a patient any drug, medicine or appliance, not being a Scheduled drug, which he personally administers or applies to that patient,

but shall, in either case, provide a restricted availability appliance only if it is for a person or a purpose specified in the Drug Tariff.

(2) Nothing in sub-paragraph (1) authorises a person to supply any drug or medicine to a patient otherwise than in accordance with Part 12 of the Human Medicines Regulations 2012 .

PART 4 — persons who perform services

Qualifications of performers

48

(1) Subject to sub-paragraph (2), no medical practitioner shall perform medical services under the contract unless he is –

(a) included in the primary medical services performers list maintained by that Board;

(b) not suspended from that list or from the Medical Register; and

(2) Sub-paragraph (1)(a) shall not apply in the case of –

(a) a medical practitioner employed by a Heath and Social Services Trust, (in Scotland) a Health Board, an NHS Trust or an NHS foundation trust who is providing services other than primary medical services at the practice premises;

(b) a person who is provisionally registered under section 15, 15A or 21 of the Medical Act 1983[^f00082] acting in the course of his employment in a resident medical capacity in an approved medical practice; or

(c) a GP Registrar who has applied to a Board to have his name included in its primary medical services performers list until the first of the following events arises –

(i) the Board notifies him of its decision on that application; or

(ii) the end of a period of two months, starting with and including the date on which his vocational training scheme began.

(d) a medical practitioner who is undergoing a programme of post-registration supervised clinical practice approved by the General Medical Council , but only in so far as any medical services such a medical practitioner performs constitute part of that programme.

(3) In this paragraph, “vocational training scheme” has the meaning given in regulation 2 of the Health and Personal Social Services (Primary Medical Services Performers Lists) Regulations (Northern Ireland ) 2004.

49

No health care professional other than one to whom paragraph 48 applies shall perform clinical services under the contract unless he is appropriately registered with his relevant professional body and his registration is not currently suspended.

50

Where the registration of a health care professional or, in the case of a medical practitioner, his inclusion in a primary medical services performers list is subject to conditions, the contractor shall ensure compliance with those conditions insofar as they are relevant to the contract.

51

No health care professional shall perform any clinical services unless he has such clinical experience and training as are necessary to enable him properly to perform such services.

Conditions for employment and engagement

52

(1) Subject to sub-paragraphs (2) and (3), a contractor shall not employ or engage a medical practitioner (other than one falling within paragraph 48(2)), unless –

(a) that practitioner has provided him with the name and address of the Board on whose primary medical services performers list he appears; and

(b) the contractor has checked that the practitioner meets the requirements in paragraph 48.

(2) Where the employment or engagement of a medical practitioner is urgently needed and is not possible for the contractor to check the matters referred to in paragraph 48 in accordance with sub-paragraph (1)(b) before employing or engaging him he may be employed or engaged on a temporary basis for a single period of up to 7 days whilst such checks are undertaken.

(3) Where the prospective employee is a GP Registrar, the requirements set out in sub-paragraph (1) shall apply with the modifications that –

(a) the name and address provided under sub-paragraph (1) may be the name and address of the Board on whose primary medical services performers list he has applied for inclusion; and

(b) confirmation that his name appears on those lists shall not be required until the end of the first two months of the Registrar’s training period.

53

(1) A contractor shall not employ or engage –

(a) a health care professional other than one to whom paragraph 48 applies unless the contractor has checked that he meets the requirements in paragraph 49; or

(b) a health care professional to perform clinical services unless he has taken reasonable steps to satisfy himself that he meets the requirements in paragraph 51.

(2) Where the employment or engagement of a health care professional is urgently needed and it is not possible to check the matters referred to in paragraph 49 in accordance with sub-paragraph (1)(b) before employing or engaging him, he may be employed or engaged on a temporary basis for a single period of up to 7 days whilst such checks are undertaken.

(3) When considering a health care professional’s experience and training for the purposes of sub-paragraph (1)(b), the contractor shall have regard in particular to –

(a) any post-graduate or post-registration qualification held by the health care professional; and

(b) any relevant training undertaken by him and any relevant clinical experience gained by him.

54

(1) The contractor shall not employ or engage a health care professional to perform medical services under the contract , other than a medical practitioner falling within paragraph 48(2)(d), unless –

(a) that person has provided two clinical references, relating to two recent posts (which may include any current post) as a health care professional which lasted for three months without a significant break, or where this is not possible, a full explanation and alternative referees; and

(b) the contractor has checked and is satisfied with the references.

(2) Where the employment or engagement of a health care professional is urgently needed and it is not possible to obtain and check the references in accordance with sub-paragraph (1)(b) before employing or engaging him, he may be employed or engaged on a temporary basis for a single period of up to 14 days whilst his references are checked and considered, and for an additional single period of a further 7 days if the contractor believes the person supplying those references is ill, on holiday or otherwise temporarily unavailable.

(3) Where the contractor employs or engages the same person on more than one occasion within a period of three months, he may rely on the references provided on the first occasion, provided that those references are not more than twelve months old.

55

(1) Before employing or engaging any person to assist him in the provision of services under the contract, the contractor shall take reasonable care to satisfy himself that the person in question is both suitably qualified and competent to discharge the duties for which he is to be employed or engaged.

(2) The duty imposed by sub-paragraph (1) is in addition to the duties imposed by paragraphs 52 to 54.

(3) When considering the competence and suitability of any person for the purpose of sub-paragraph (1), the contractor shall have regard, in particular, to –

(a) that person’s academic and vocational qualifications;

(b) his education and training; and

Training

56

The contractor shall ensure that for any health care professional who is –

(a) performing clinical services under the contract; or

(b) employed or engaged to assist in the performance of such services

there are in place arrangements for the purpose of maintaining and updating his skills and knowledge in relation to the services which he is performing or assisting in performing.

57

The contractor shall afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee’s competence.

Terms and conditions

58

The contractor shall only offer employment to a general medical practitioner on terms and conditions which are no less favourable than those contained in the “Model terms and conditions of service for a salaried general practitioner employed by a GMS practice” published by the British Medical Association and the NHS Confederation as item 1.2 of the supplementary documents to the new GMS contract 2003[^f00083].

Arrangements for GP Registrars

59

(1) The contractor shall only employ a GP Registrar... subject to the conditions in sub-paragraph (2).

(2) The conditions referred to in sub-paragraph (1) are that the contractor shall not, by reason only of having employed or engaged a GP Registrar, reduce the total number of hours for which other medical practitioners perform primary medical services under the contract or for which other staff assist them in the performance of those services.

(3) A contractor which employs a GP Registrar shall –

(a) offer him terms of employment in accordance with the rates and subject to the conditions contained in any guidance given by the Department concerning the grants, fees, travelling and other allowances payable to GP Registrars; and

(b) take into account any guidance issued by the Department in relation to the GP Registrar Scheme.

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