If the contractor breaches the condition specified in paragraph 64 (10) and it comes to the Board’s attention that the contractor has done so, the Board shall serve a notice in writing on the contractor –

(a) terminating the contract forthwith; or

(b) instructing him to terminate the sub-contracting arrangements that give rise to the breach forthwith, and if he fails to comply with the instruction, the Board shall serve a notice in writing on the contractor terminating the contract forthwith.

Termination by the Board: remedial notices and breach notices

Termination by the Board: additional provisions specific to contracts with two or more individuals practising in partnership and companies limited by shares

Contract sanctions

Contract sanctions and the dispute resolution procedure

Termination and the dispute resolution procedure

Consultation with the Local Medical Committee

Repeatable prescribing services

39A

(1) The contractor may only provide repeatable prescribing services to any person on its list of patients if he –

(a) satisfies the conditions in sub-paragraph (2); and

(b) has notified the Board of his intention to provide repeatable prescribing services in accordance with sub-paragraphs (3) and (4).

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

(a) the contractor holds a contract with a Board

(b) the contractor has access to computer systems and software which enable him to issue repeatable prescriptions and batch issues; and

(c) the practice premises at which the repeatable prescribing services are to be provided are located in an area of the Board in which there is also located the premises of at least one chemist who has undertaken to provide, or has entered into an arrangement to provide, repeat dispensing services.

(3) The notification referred to in sub-paragraph (1)(b) is a notification, in writing, by the contractor to the Board that he –

(a) wishes to provide repeatable prescribing services; and

(b) intends to begin to provide those services from a specified date; and

(4) The date specified by the contractor pursuant to sub-paragraph (3)(b) must be at least ten days after the date on which the notification specified in sub-paragraph (1) is given.

(5) Nothing in this paragraph requires a contractor or prescriber to provide repeatable prescribing services to any person.

(6) A prescriber may only provide repeatable prescribing services to a person on a particular occasion if –

(a) that person has agreed to receive such services on that occasion; and

(b) the prescriber considers that it is clinically appropriate to provide such services to that person on that occasion.

(7) The contractor may not provide repeatable prescribing services to any patient of his to whom –

(a) he is authorised or required by the Board to provide dispensing services under paragraph 44; or

(b) any of the persons specified in sub-paragraph (8) is authorised or required by the Board under regulation 12 of the Pharmaceutical Regulations to provide pharmaceutical services.

(8) The persons referred to in sub-paragraph (7) are –

(a) in the case of a contract with an individual medical practitioner, that medical practitioner;

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

(c) in the case of a contract with a company, any medical practitioner who is a legal and beneficial shareholder in that company; or

(d) any medical practitioner employed by the contractor.

Repeatable prescriptions

39B

(1) A prescriber who issues a repeatable prescription must at the same time issue the appropriate number of batch issues.

(2) A prescriber who has provided repeatable prescribing services to a person must, as soon as is practicable, notify that person, and make reasonable efforts to contact the chemist providing repeat dispensing services to that person, if –

(a) he makes any change to the type, quantity, strength or dosage of drugs, medicines or appliances ordered on that person’s repeatable prescription; or

(b) he considers that it is no longer appropriate or safe for that person to receive the drugs, medicines or appliances ordered on his repeatable prescription, or no longer appropriate or safe for him to continue to receive repeatable prescribing services.

(3) If a prescriber provides repeatable prescribing services to a person in respect of whom he has previously issued a repeatable prescription which has not yet expired (for example, because that person wishes to obtain the drugs, medicines or appliances from a different chemist), the prescriber must make reasonable efforts to notify the chemist which has in its possession the repeatable prescription which is no longer required.

(4) If a prescriber has issued a repeatable prescription in respect of a person, and (before the expiry of that repeatable prescription) it comes to his notice that that person has been removed from the list of patients of the contractor on whose behalf the prescription was issued, that prescriber must –

(a) notify that person; and

(b) make reasonable efforts to notify the chemist who has been providing repeat dispensing services to that person, that the repeatable prescription should no longer be used to obtain or provide repeat dispensing services.

Restrictions on prescribing by medical practitioners

Restrictions on prescribing by supplementary prescribers

Interpretation of paragraphs 38, 39, 40 and 41

Excessive prescribing

Provision of dispensing services

Terms relating to the provision of dispensing services

Dispensing contractor list

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

19A

If the contractor offers repeatable prescribing services, the arrangements for providing such services.

Telephone services

1A

(1) The contractor shall not be a party to any contract or other arrangement under which the number for telephone services to be used—

(a) by patients to contact the practice for any purpose related to the contract; or

(b) by any other person to contact the practice in relation to services provided as part of the health service,

starts with the digits 087, 090 or 091 or consists of a personal number, unless the service is provided free to the caller.

(2) In this paragraph, “personal number” means a telephone number which starts with the number 070 followed by a further 8 digits.

Attendance at practice premises

Attendance outside practice premises

Newly registered patients

Patients not seen within three years

Patients aged 75 years and over

Clinical reports

Storage of vaccines

Infection control

Criteria for out of hours services

Standards for out of hours services

Supply of medicines, etc. by contractors providing out of hours services

11A

(1) In this paragraph—

“the Charges Regulations” means the Charges for Drugs and Appliances Regulations (Northern Ireland) 1997;

“complete course” means the course of treatment appropriate to the patient’s condition, being the same as the amount that would have been prescribed if the patient had been seen during core hours;

“necessary drugs, medicines and appliances” means those drugs, medicines and appliances which the patient requires and for which, in the reasonable opinion of the contractor, and in the light of the patient’s medical condition, it would not be reasonable in all the circumstances for the patient to wait until such time as he could obtain them during core hours;

“out of hours performer” means a prescriber, a person acting in accordance with a Patient Group Direction or any other health care professional employed or engaged by the contractor who can lawfully supply a drug, medicine or appliance, who is performing out of hours services under the contract;

“Patient Group Direction” has the same meaning as in the the Human Medicines Regulations 2012 ; and

“supply form” means a form provided by the RBSO and completed by or on behalf of the contractor for the purpose of recording the provision of drugs, medicines or appliances to a patient during the out of hours period.

(2) Where a contractor whose contract includes the provision of out of hours services has agreed with the Board that its contract should also include the supply of necessary drugs, medicines or appliances to patients at the time that it is providing them with out of hours services, the contractor shall comply with the requirements in sub-paragraphs (3) to (5).

(3) The contractor shall ensure that an out of hours performer—

(a) only supplies necessary drugs, medicines and appliances;

(b) supplies the complete course of the necessary medicine or drug required to treat the patient; and

(i) drugs, medicines or appliances which he could not lawfully supply,

(ii) appliances which are not listed in Part IX of the Drug Tariff,

(iii) restricted availability appliances, except where the patient is a person, or it is for a purpose, specified in the Drug Tariff, or

(iv) a drug, medicine or other substance listed in Schedule 1 to the Health and Personal Social Services (General Medical Services Contracts) (Prescription of Drugs Etc) Regulations (Northern Ireland) 2004, or a drug, medicine or other substance listed in Schedule 2 to those Regulations other than in the circumstances specified in that Schedule.

(4) The out of hours performer shall record on a separate supply form for each patient any drugs, medicines or appliances supplied to that patient.

(5) The out of hours performer shall—

(a) ask any person who makes a declaration that the patient does not have to pay the charges specified in regulation 4(1) of the Charges Regulations by virtue of either—

(i) entitlement to exemption under regulation 7(1) of the Charges Regulations, or

(ii) entitlement to remission of charges under regulation 5 of the Travelling Expenses and Remission of Charges Regulations (Northern Ireland) 2004,

to produce satisfactory evidence of such entitlement, unless the declaration is in respect of entitlement to exemption by virtue of sub-paragraph (a), (c), (d), (e), (f) or (g) of regulation 7(1) of the Charges Regulations, and at the time of the declaration the out of hours performer already has such evidence available to him; and

(b) if no satisfactory evidence is produced to him (and where it is relevant, none is already available to him as mentioned in paragraph (a)), endorse the supply form to that effect.

(6) Subject to sub-paragraph (7), nothing in this paragraph shall prevent an out of hours performer supplying a Scheduled drug or restricted availability appliance in the course of treating a patient under a private arrangement.

(7) The provisions of regulation 24 (fees and charges) apply in respect of the supply of necessary drugs, medicines and appliances as they apply in respect of prescriptions for drugs, medicines and appliances.

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

Termination on the death of an individual medical practitioner

99A

(1) Where the contract is with an individual medical practitioner and that practitioner dies, the contract shall terminate at the end of the period seven days after the date of his death unless, before the end of that period—

(a) the Board has agreed in writing with the contractor’s personal representatives that the contract should continue for a further period , not exceeding 28 days after the end of the period of seven days; and

(b) the contractor’s personal representatives have consented in writing to the Board employing or supplying one or more general medical practitioners to assist in the provision of clinical services under the contract throughout the period for which it continues.

(2) In sub-paragraph (1), “general medical practitioner” has the same meaning as in regulation 4(1).

(3) Sub-paragraph (1) does not affect any other rights to terminate the contract which the Board may have under paragraphs 104 to 107.

Termination by the contractor

Late payment notices

Termination by the Board: general

Termination by the Board for breach of conditions in regulation 4

Termination by the Board for the provision of untrue etc. information

Other grounds for termination by the Board

Termination by the Board for unlawful sub-contracting

Termination by the Board: remedial notices and breach notices

Termination by the Board: additional provisions specific to contracts with two or more individuals practising in partnership and companies limited by shares

Contract sanctions

Contract sanctions and the dispute resolution procedure

Termination and the dispute resolution procedure

Consultation with the Local Medical Committee

Independent nurse prescribers , pharmacist independent prescribers and supplementary prescribers

childhood vaccines and immunisations

Cost of relevant calls

1B

(1) The contractor must not enter into, renew or extend a contract or other arrangement for telephone services unless it is satisfied that, having regard to the arrangement as a whole, persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number.

(2) Where a contractor is party to an existing contract or other arrangement for telephone services under which persons making relevant calls to the practice call a number which is not a geographical number, the contractor must comply with sub-paragraph (3).

(3) The contractor must—

(a) before 1st April 2014, review the arrangement and consider whether, having regard to the arrangement as a whole, persons pay more to make relevant calls than they would to make equivalent calls to a geographical number; and

(b) if the contractor so considers, take all reasonable steps, including in particular considering the matters specified in sub-paragraph (4), to ensure that, having regard to the arrangement as a whole, persons will not pay more to make relevant calls than they would to make equivalent calls to a geographical number.

(4) The matters referred to in sub-paragraph (3)(b) are—

(a) varying the terms of the contract or arrangement;

(b) renegotiating the terms of the contract or arrangement;

(5) If, despite taking all reasonable steps referred to in sub-paragraph (3)(b), it has not been possible to ensure that, having regard to the arrangement as a whole, persons will not pay more to relevant calls to the practice than they would to make equivalent calls to a geographical number, the contractor must consider introducing a system under which if a caller asks to be called back, the contractor will do so at the contractor’s expense.

(6) In this paragraph—

“existing contract or other arrangement” means a contract or arrangement that was entered into prior to 1st April 2013 and which remains in force on 1st April 2013;

“geographical number” means a number which has a geographical area code as its prefix; andmade by patients to the practice for any reason related to services provided under the contract, andmade by persons, other than patients, to the practice in relation to services provided as part of the health service.

Attendance at practice premises

Attendance outside practice premises

Newly registered patients

Patients not seen within three years

Patients aged 75 years and over

Clinical reports

Storage of vaccines

Infection control

Criteria for out of hours services

Standards for out of hours services

Supply of medicines, etc. by contractors providing out of hours services

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

Application for closure of lists of patients

29A

(1) A contractor which wishes to close its list of patients must send a written application (“the Application”) to close its list to the Board and the Application must include the following details—

(a) the options which the contractor has considered, rejected or implemented in an attempt to relieve the difficulties which the contractor has encountered in respect of its open list and, if any of the options were implemented, the level of success in reducing or extinguishing such difficulties;

(b) any discussions between the contractor and its patients and a summary of those discussions including whether in the opinion of those patients the list of patients should or should not be closed;

(c) any discussions between the contractor and other contractors in the practice area and a summary of the opinion of the other contractors as to whether the list of patients should or should not be closed;

(d) the period of time during which the contractor wishes its list of patients to be closed and that period must not be less than 3 months and not more than 12 months;

(e) any reasonable support from the Board which the contractor considers would enable its list of patients to remain open or would enable the period of proposed closure to be minimised;

(f) any plans the contractor may have to alleviate the difficulties mentioned in that Application during the period the list of patients may be closed in order for that list to reopen at the end of the proposed closure period without the existence of those difficulties; and

(g) any other information which the contractor considers ought to be drawn to the attention of the Board.

(2) The Board must acknowledge receipt of the Application within a period of 7 days starting on and including the date the Application was received by the Board.

(3) The Board must consider the Application and may request such other information from the contractor which it requires to enable it to consider the Application.

(4) The Board must enter into discussions with the contractor concerning—

(a) the support which the Board may give to the contractor; or

(b) changes which the Board or contractor may make,

to enable the contractor to keep its list of patients open.

(5) The Board and the contractor must, throughout the discussions referred to in sub-paragraph (4), use its reasonable endeavours to achieve the aim of keeping the contractor’s list of patients open.

(6) The Board or the contractor may, at any stage during the discussions, invite the Local Medical Committee for the area to attend any meetings arranged between the Board and contractor to discuss the Application.

(7) The Board may consult such persons as it appears to the Board may be affected by the closure of the contractor’s list of patients, and if it does so, the Board must provide to the contractor a summary of the views expressed by those consulted in respect of the Application.

(8) The Board must enable the contractor to consider and comment on all the information before the Board makes a decision in respect of the Application.

(9) A contractor may withdraw its Application at any time before the Board makes a decision in respect of that Application.

(10) Within a period of 21 days starting on and including the date of receipt of the Application (or within such longer period as the parties may agree), the Board must make a decision—

(a) to approve the Application and determine the date the closure is to take effect snd the date the list of patients is to reopen; or

(b) to reject the Application.

(11) The Board must notify the contractor of its decision to approve the Application in accordance with paragraph 29B, or in the case where the Application is rejected, in accordance with paragraph 29C.

(12) A contractor must not submit more than one application to close its list of patients in any period of 12 months starting on and including the date on which the Board makes its decision on the Application unless—

(a) paragraph 29C applies; or

(b) there has been a change in the circumstances of the contractor which affects its ability to deliver services under the contract.

Approval of an application to close a list of patients

29B

(1) Where the Board approves an application to close a list of patients, it must—

(a) notify the contractor of its decision in writing as soon as possible and the notification (“the closure notice”) must include the details referred to in sub-paragraph (2); and

(b) at the same time as it notifies the contractor, send a copy of the closure notice to the Local Medical Committee for the area and to any person it consulted in accordance with paragraph 29A(7).

(2) The closure notice must include—

(a) the period of time for which the contractor’s list of patients will be closed which must be—

(i) the period specified in the application to close the list of patients; or

(ii) in the case where the Board and contractor have agreed in writing a different period, that different period, and in either case, the period must be not less than 3 months and not more than 12 months;

(b) the date from which the closure of the list of patients is to take effect; and

(3) Subject to paragraph 29E, a contractor must close its list of patients with effect from the date the closure of the list of patients is to take effect and the list of patients must remain closed for the duration of the closure period as specified in the closure notice.

Rejection of an application to close a list of patients

29C

(1) Where a Board rejects an application to close a list of patients it must—

(a) notify the contractor of its decision in writing as soon as possible and the notification must include the reasons for the rejection of the application; and

(b) at the same time as it notifies the contractor, send a copy of the notification to the Local Medical Committee for the area and to any person it consulted in accordance with paragraph 29A(7).

(2) Subject to sub-paragraph (3), if a Board makes a decision to reject a contractor’s application to close its list of patients, the contractor must not make a further application until—

(a) the end of the period of 3 months, starting on and including the date of the decision of the Board; or

(b) the end of the period of 3 months, starting on and including the date of the final determination in respect of a dispute arising from the decision to reject the application made pursuant to the dispute resolution procedure (or any court proceedings),

whichever is the later.

(3) A contractor may make a further application to close its list of patients where there has been a change in the circumstances of the contractor which affects its ability to deliver services under the contract.

Application for an extension to a closure period

29D

(1) A contractor may apply to extend a closure period by sending a written application to extend the closure period no later than 8 weeks before the date that period is due to expire.

(2) The application to extend the closure period must include—

(a) details of the options the contractor has considered, rejected or implemented in an attempt to relieve the difficulties which have been encountered during the closure period or which may be encountered when the closure period expires;

(b) the period of time during which the contractor wishes its list of patients to remain closed, which extended period of desired closure must not be more than 12 months;

(c) details of any reasonable support from the Board which the contractor considers would enable its list of patients to re-open or would enable the proposed extension of the closure period to be minimised;

(d) details of any plans the contractor may have to alleviate the difficulties mentioned in the application to extend the closure period in order for the list of patients to re-open at the end of the proposed extension of the closure period without the existence of those difficulties; and

(e) any other information which the contractor considers ought to be drawn to the attention of the Board.

(3) The Board must acknowledge receipt of the application for an extension to the closure period within a period of 7 days starting on and including the date the application was received by the Board.

(4) The Board must consider the application for an extension to the closure period and may request such other information from the contractor which it requires to enable it to consider that application.

(5) The Board may enter into discussions with the contractor concerning—

(a) the support which the Board may give to the contractor; or

(b) changes which the Board or contractor may make,

to enable the contractor to re-open its list of patients.

(6) Within a period of 14 days starting on and including the date of receipt of the application to extend the closure period (or within such longer period as the parties may agree), the Board must make a decision.

(7) The Board must notify the contractor of its decision to approve or reject the application to extend the closure period as soon as possible after making its decision.

(8) Where the Board approves the application to extend the closure period, it must—

(a) notify the contractor of its decision in writing and the notification (“the extended closure notice”) shall include the details referred to in sub-paragraph (9); and

(b) at the same time as it notifies the contractor, send a copy of the extended closure notice to the Local Medical Committee for the area and to any person it consulted in accordance with paragraph 29A(7).

(9) The extended closure notice must include—

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