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The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004

Type Scottish-Statutory-Instrument

Publication 2004-03-10

State In force

Jurisdiction Scotland

Department Queen's Printer for Scotland

Source legislation.gov.uk

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(b) the provider 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 a person specified in sub-paragraph (5); or

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

(a) an individual that is a party to the agreement;

(b) a partner in a partnership that is a party to the agreement;

(d) a member of the provider’s staff;

(e) a person engaged by the provider to perform or assist in the performance of services under the agreement; 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 agreement.

(6) The provider 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 provider shall keep a written record of refusals 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 Health 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 Health Board receives notification of the registration of the person with another provider (by any arrangement) of essential services (or their equivalent); or

(b) the eighth day after the Health 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 provider is treating the patient at intervals of less than 7 days, the provider shall notify the Health Board in writing of the fact and the removal shall take effect–

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

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

whichever is the sooner.

(10) The Health Board shall notify in writing–

(a) the patient; and

(b) the provider,

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

Removal from the list of patients who are violent

14

(1) A provider which wishes a patient to be removed from its 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 that person’s own safety; and

(b) the provider has reported the incident to the police or the Procurator Fiscal,

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

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

(a) an individual that is a party to the agreement;

(b) a partner in a partnership that is a party to the agreement;

(d) a member of the provider’s staff;

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

(f) any other person present–

(i) on the practice premises; or

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

(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 7 days (and for this purpose a faxed notification or transmission by electronic means is not a written one).

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

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

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

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

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

(a) it is not reasonably practicable for the provider to do so; or

(b) the provider 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 Health Board has removed a patient from the provider’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 provider’s list of patients in accordance with this paragraph, the provider shall record in the patient’s medical records that the patient has been removed under this paragraph and the circumstances leading to the patient’s removal.

Removals from the list of patients registered elsewhere

15

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

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

(b) it has received notice from another Health Board, Primary Care trust, Local Health Board, or a Health and Social Services Board that the patient has subsequently been registered with a provider (by any arrangement) of essential services (or their equivalent) outside the area of the Health Board.

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

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

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

(3) The Health Board shall notify the provider in writing of persons removed from the provider’s list of patients under sub-paragraph (1).

Removals from list of patients who have moved

16

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

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

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

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

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

Removals from list of patients who have moved

17

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

(a) give to the provider notice in writing that it intends, at the end of the period of 6 months commencing with the date of the notice, to remove the patient from the provider’s list of patients; and

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

Removals from the list of patients absent from the United Kingdom

18

(1) The Health Board shall remove a patient from the provider’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 died.

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

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

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

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

Removals from the list of patients accepted elsewhere as temporary residents

19

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

(a) that the person’s stay in the place of temporary residence has exceeded 3 months; and

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

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

(a) the provider; and

(b) where practicable, the patient.

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

(a) the patient’s entitlement to make arrangements for the provision to the patient of essential services (or their equivalent), including by the provider (by any arrangement) by which the patient has been treated as a temporary resident; and

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

Removals from the list of pupils etc. of a school

20

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

(2) Where the Health 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 provider as to whether it should remove from its list of patients any persons appearing on that list as pupils at, or staff of, that school.

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

Closure of lists of patients

21

(1) A provider which wishes to close its list of patients shall notify the Health Board in writing to that effect.

(2) Within a period of 7 days beginning with the date of receipt of the notification referred to in sub-paragraph (1), or, if that is not reasonably practicable, as soon as is practicable thereafter, the Health Board shall enter into discussions with the provider concerning the support which the Health Board may give the provider, or other changes which the Health Board or the provider may make, which would enable the provider to keep its list of patients open.

(3) In the discussions referred to in sub-paragraph (2) both parties shall use reasonable endeavours to achieve the aim of keeping the provider’s list of patients open.

(4) The discussions mentioned in sub-paragraph (2) shall be completed within a period of 28 days beginning with the date of the Health Board’s receipt of the notification referred to in sub paragraph (1), or within such longer period as the parties may agree.

(5) If, following the discussions mentioned in sub-paragraph (2), the Health Board and the provider reach agreement that the provider’s list of patients should remain open, the Health Board shall send full details of the agreement in writing to the provider.

(6) The Health Board and the provider shall comply with the terms of an agreement reached as mentioned in sub-paragraph (5).

(7) If, following the discussions mentioned in sub-paragraph (2)–

(a) the Health Board and the provider reach agreement that the provider’s list of patients should close; or

(b) the Health Board and the provider fail to reach agreement and the provider still wishes to close the provider’s list of patients,

the provider shall send a closure notice to the Health Board.

(8) A closure notice shall be submitted in the form specified in Schedule 5, and shall include the following details which (in a case falling within sub-paragraph (7)(a)) have been agreed between the parties or (in a case falling within sub-paragraph (7)(b)) are proposed by the provider:–

(a) the period of time (which may not exceed 12 months) for which the provider’s list of patients will be closed;

(b) the current number of the provider’s registered patients;

(c) the number of registered patients (lower than the current number of such patients, and expressed either in absolute terms or as a percentage of the number of such patients specified pursuant to paragraph (b)) which, if that number were reached, would trigger the re-opening of the provider’s list of patients;

(d) the number of registered patients (expressed either in absolute terms or as a percentage of the number of such patients specified pursuant to paragraph (b)) which, if that number were reached, would trigger the re-closure of the provider’s list of patients; and

(e) any withdrawal or reduction in provision of any additional or enhanced services which had previously been provided under the agreement.

(9) The Health Board shall forthwith acknowledge receipt of the closure notice in writing to the provider.

(10) Before the Health Board reaches a decision as to whether to approve or reject the closure notice under sub-paragraph (12), the Health Board and the provider may enter into further discussions concerning the details of the closure notice as specified in sub-paragraph (8), with a view to reaching agreement; and, in particular, if the parties are unable to reach agreement regarding the period of time for which the provider’s list of patients will be closed, that period shall be 12 months.

(11) A provider may not withdraw a closure notice for a period of 3 months beginning with the date on which the Health Board has received the notice, unless the Health Board has agreed otherwise in writing.

(12) Within a period of 14 days beginning with the date of receipt of the closure notice, the Health Board shall–

(a) approve the closure notice; or

(b) reject the closure notice,

and shall notify the provider of its decision in writing as soon as possible.

(13) Approval of the closure notice under sub-paragraph (12)(a) includes approval of the details specified in accordance with sub-paragraph (8) (or, where those details are revised following discussions under sub-paragraph (10), approval of those details as so revised).

Approval of closure notice by the Health Board

22

(1) If the Health Board approves the closure notice in accordance with paragraph 21(12)(a), the provider shall close the provider’s list of patients–

(a) with effect from a date agreed between the Health Board and the provider; or

(b) if no such agreement has been reached, with effect from that date on which the provider receives notification of the Health Board’s decision to approve the closure notice.

(2) Subject to sub-paragraph (3), the provider’s list of patients shall remain closed for the period specified in the closure notice in accordance with paragraph 21(8)(a) (or, where a period of 12 months has been fixed in accordance with paragraph 21(10), for that period).

(3) The provider’s list of patients shall re-open before the expiry of the period mentioned in sub paragraph (2) if–

(a) the number of the provider’s registered patients falls to the number specified in the closure notice in accordance with paragraph 21(8)(c);

(b) the Health Board and the provider agree that the list of patients should re-open.

(4) If the provider’s list of patients has re-opened pursuant to sub-paragraph (3)(a) it shall nevertheless close again if, during the period specified in the closure notice in accordance with paragraph 21(8)(a) or, where the period of 12 months specified in paragraph 21(10) applies, during that period) the number of the provider’s registered patients rises to the number specified in the closure notice in accordance with paragraph 21(8)(d).

(5) Except in cases where the provider’s list of patients is already open pursuant to sub paragraph (3), the Health Board shall notify the provider in writing between 7 and 14 days before the expiry of the period of closure specified in sub-paragraph (2), confirming the date on which the provider’s list of patients will re-open.

(6) Where the details specified in the closure notice in accordance with paragraph 21(8) have been revised following discussions under paragraph 21(10), references in this paragraph to details specified in the closure notice are references to those details as so revised.

Rejection of closure notice by the Health Board

23

(1) This regulation applies where the Health Board rejects the closure notice in accordance with paragraph 21(12)(b).

(2) The provider and the Health Board may not refer the matter for determination in accordance with the NHS dispute resolution procedure (or, where applicable, in the case of a non-NHS contract, commence court proceedings) until the assessment panel has given its determination in accordance with the following sub-paragraphs.

(3) The Health Board must ensure that the assessment panel is appointed by another Health Board as soon as is practicable to consider and determine whether the provider should be permitted to close its list of patients, and if so, the terms on which the provider should be permitted to do so.

(4) The Health Board shall provide the assessment panel with such information as the assessment panel may reasonably require to enable the panel to reach a determination and shall include in such information any written observations received from the provider.

(5) At least one member of the assessment panel shall visit the provider before reaching a determination under sub-paragraph (6).

(6) Within the period of 28 days beginning with the date on which the Health Board rejected the closure notice, the assessment panel shall–

(a) approve the list closure; or

(b) reject the list closure,

and shall notify the Health Board and the provider of its determination in writing as soon as possible.

(7) Where the assessment panel determines in accordance with sub-paragraph (6)(a) that the provider’s list of patients should close, it shall specify–

(a) a date from which the closure shall take effect, which must be within a period of 7 days beginning with the date of the assessment panel’s determination; and

(b) those details specified in paragraph 21(8).

(8) Where the assessment panel rejects the list closure in accordance with sub-paragraph (6)(b) that list shall remain open, and the Health Board and the provider shall enter into discussions with a view to ensuring that the provider receives support from the Health Board which will enable the provider to continue to provide services safely and effectively.

(9) Where the assessment panel rejects the list closure in accordance with sub-paragraph (6)(b) the provider may not submit a further closure notice as described in paragraph 21 until–

(a) the expiry of a period of three months beginning with the date of the assessment panel’s determination; or

(b) (if applicable) the final determination of the NHS dispute resolution procedure (or any court proceedings),

whichever is the later, unless there has been a change in the circumstances of the provider which affects its liability to deliver services under the agreement.

(10) Any decision or determination by the assessment panel for the purposes of this paragraph may be reached by a majority.

Assignment of patients to lists: open lists

24

(1) A Health Board may, subject to paragraph 26, assign a new patient to a provider whose list of patients is open.

(2) In this paragraph and in paragraphs 25 and 27 to 29, a “new” patient means a person who–

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

(b) has been refused inclusion in a list of patients of, or has not been accepted as a temporary resident by, a provider (by any arrangement) of essential services (or their equivalent) whose premises are within such an area; and

(c) wishes to be included in the list of patients of a provider (by any arrangement) of essential services (or their equivalent) whose practice premises are within that area.

Assignment of patients to lists: closed lists

25

(1) A Health Board may not assign a patient to a provider which has closed the provider’s list of patients except in the circumstances specified in sub-paragraph (2).

(2) A Health Board may, subject to paragraph 26 assign a new patient to a provider whose practice premises are within the Health Board’s area and which has closed the provider’s list of patients, if–

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

(b) the assessment panel has determined under paragraph 27(7) that patients may be assigned to the provider in question, and that determination has not been overturned either by a determination of the Scottish Ministers or the adjudicator under the NHS dispute resolution procedure as modified by paragraph 28 or (where applicable) by a court; and

(c) the Health Board has entered into discussions with the provider in question regarding the assignment of a patient if such discussions are required under paragraph 29.

Factors relevant to assignments

26

In making an assignment to a provider under paragraph 24 or 25, the Health 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 provider’s practice premises;

(c) whether during the 6 months ending on the date on which the application for assignments is received by the Health Board, the patient’s name has been removed from the list of patients of a provider in the area of the Health Board under paragraph 13 or its equivalent provision in relation to a general medical services contractor in the area of the Health Boardtype=start time=1185530620754;type=end time=1185530620754

(d) whether the patient’s name has been removed from the list of patients of a provider in the area of the Health Board under paragraph 14 or its equivalent provision in relation to a general medical services contractor in the area of the Health Board and, if so, whether the provider has appropriate facilities to deal with such a patient; and

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

Assignments to closed lists: determination of the assessment panel

27

(1) This paragraph applies where most or all of the providers (by any arrangement) of essential services (or their equivalent) whose practice premises are within the area of a Health Board have closed their lists of patients.

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

(3) The Health Board must ensure that the assessment panel is appointed to consider and determine its proposal made under sub paragraph (2).

(4) The Health Board shall notify in writing–

(a) providers or general medical services contractors whose practice premises are within the Health Board’s area which–

(i) have closed their list of patients; and

(ii) may, in the opinion of the Health Board, be affected by the determination of the assessment panel; and

(b) the area medical committee, for the area of the Health Board,

that it has referred the matter to the assessment panel.

(5) In reaching its determination, the assessment panel shall have regard to relevant factors including–

(a) whether the Health Board has attempted to secure the provision of essential services (or their equivalent) for new patients other than by means of their assignment to providers with closed lists of patients; and

(b) the workload of those providers likely to be affected by any decision to assign such patients to their list of patients.

(6) The assessment panel shall reach a determination within the period of 28 days beginning with the date on which the panel was appointed.

(7) The assessment panel shall determine whether the Health Board may assign patients to providers which have closed their lists of patients; and if it determines that the Health Board may make such assignments, it shall also determine those providers to which patients may be assigned.

(8) The assessment panel may determine that the Health Board may assign patients to providers other than those providers specified by the Health Board in its proposal under sub paragraph (2), as long as the providers were notified under sub paragraph (4)(a).

(9) The assessment panel’s determination shall include its comments on the matters specified in sub paragraph (5), and shall be notified in writing to those providers which were notified under sub paragraph (4)(a).

(10) Any decision or determination by the assessment panel for the purposes of this paragraph may be reached by a majority .

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

28

(1) Where an assessment panel makes a determination under paragraph 27(7) that the Health Board may assign new patients to providers which have closed their lists of patients, any provider specified in that determination may refer the matter in dispute to the Scottish Ministers to review the determination of the assessment panel.

(2) Where more than one provider specified in the determination in accordance with paragraph 27(7) wishes to refer the matter for dispute resolution, those providers may, if they all agreed, refer the matter jointly, and in that case the Scottish Ministers shall review the matter in relation to those providers together.

(3) Where a matter is referred to the Scottish Ministers under sub-paragraph (1) or (2), it shall be determined in accordance with the NHS dispute resolution procedure as modified as follows–

(a) in paragraph 56(3) of Schedule 1, for “a dispute as mentioned in sub-paragraph (1)” substitute “the matter as mentioned in paragraph 28(1)”;

(b) for paragraph 56(4) of Schedule 1, substitute–

(4) The provider (or providers) wishing to refer the matter as mentioned in paragraph 28(1) of Schedule 2 must send the request to the Scottish Ministers within the period of 7 days beginning with the date of the determination by the assessment panel in accordance with paragraph 21(7) of Schedule 2.

(13) In this paragraph, “specified period” means such period as the Scottish Ministers shall specify in the request sent under sub-paragraphs (6) or(8), being not less than 1, nor more than 2, weeks beginning with the date on which the request is given, but the adjudicator may, if the period for determination of the dispute has been extended in accordance with sub-paragraph (19), extend any such period (even after it has expired) and, where the adjudicator does so, a reference in this paragraph to the specified period is to the period as so extended;

(d) after paragraph 56(15) of Schedule 1, there shall be inserted the following sub paragraphs–

(16) Subject to paragraph (19), within the period of 21 days beginning with the date on which the matter was referred to the Scottish Ministers, the adjudicator shall determine whether the Health Board may assign patients to providers which have closed their lists of patients; and if the adjudicator determines that the Health Board may make such assignments, the adjudicator shall also determine those providers to which patients may be assigned. (17) The adjudicator may not determine that patients may be assigned to a provider which was not specified in the determination of the assessment panel under paragraph 27(7) of Schedule 2. (18) In the case of a matter referred jointly by providers in accordance with paragraph 28(2) of Schedule 2, the adjudicator may determine that patients may be assigned to one, some or all of the providers which referred the matter. (19) The period of 21 days referred to ins sub-paragraph (15) 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 adjudicator; (b) the Health Board; and (c) the provider (or providers) which referred the matter to dispute resolution.

; and

(e) paragraph 57(2) and (3) of Schedule 1 shall not apply.

Assignments to closed lists: assignments of patients by a Health Board

29

(1) Before the Health Board may assign a new patient to a provider, it shall, subject to sub paragraph (3), enter into discussions with that provider regarding additional support that the Health Board can offer the provider, and the Health 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 provider; and

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

PART 3 — RECORDS AND NOTICES

Patients records: supplemental

30

(1) The provider shall send the complete records relating to a patient to the Health Board–

(a) where a person on the provider’s list of patients dies, before the end of the period of 14 days beginning with the date on which it was informed by the Health Board of the death, or (in any other case) before the end of the period of 1 month beginning with the date on which the provider learned of the death; or

(b) in any other case where the patient is no longer registered with the provider, as soon as possible, at the request of the Health Board.

(2) To the extent that a patient’s records are records created by way of entries on a computer, the provider complies with sub-paragraph (1) if it sends to the Health Board a copy of those records–

(a) in written form; or

(b) with the written consent of the Health Board, in any other form.

(3) The consent of the Health Board to the transmission of information other than in written form for the purposes of sub-paragraph (2)(b) shall not be withheld or withdrawn provided it is satisfied, and continues to be satisfied, with the following matters–

(a) the provider’s proposals as to how the record will be transmitted;

(b) the provider’s proposals as to the format of the transmitted record;

(d) how a written copy of the record can be produced by the Health Board.

Notifications to the Health Board

31

The provider shall notify the Health Board in writing of any person other than, where the provider has a provider’s list of patients, a registered patient or a person whom it has accepted as a temporary resident to whom it has provided the essential services described in paragraph 1(1)(c) or (d) of Schedule 2 within the period of 28 days beginning on the day that the services were provided.

SCHEDULE 3 — AGREEMENTS TO PROVIDE ADDITIONAL SERVICES

Additional services generally

1

The provider shall–

(a) provide in relation to each additional service, such facilities and equipment as are necessary to enable the provider properly to perform that service;

(b) provide each additional service, within core hours, as is appropriate to meet the reasonable needs of its patients; and

(c) have in place arrangements for its patients to access each additional service throughout the core hours in case of emergency.

Cervical screening

2

(1) A provider whose agreement includes the provision of cervical screening services shall–

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

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

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

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

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

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

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

Contraceptive services

3

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

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

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

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

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

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

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

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

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

(3) An agreement which includes the provision of contraceptive services must providetype=start time=1185530671583type=end time=1185530671583 that for the purposes of paragraphs 10 to 13 of Schedule 1 drugs includes contraceptive substances and appliances includes contraceptive appliances.

Vaccinations and immunisations

4

(1) A provider whose agreement includes the provision of vaccinations and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The provider shall–

(a) offer to provide to patients all vaccinations and immunisations (excluding childhood vaccinations and immunisations) of a type and in the circumstances for which a fee was provided for under the 2003-04 Statement of Fees and Allowances made under regulation 35 (payments) of the National Health Service (General Medical Services) (Scotland) Regulations 1995[^f00084] other than influenza vaccination;

(b) provide appropriate information and advice to patients about such vaccinations and immunisations;

(c) record in the patient’s record kept in accordance with paragraph 33 of Schedule 1 any refusal of the offer referred to in paragraph (a);

(d) where the offer is accepted, administer the vaccinations and immunisations and include in the patient’s record kept in accordance with paragraph 33 of Schedule 1–

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

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

(iii) the date of administration;

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

(v) any contraindications to the vaccination or immunisation; and

(vi) any adverse reactions to the vaccination or immunisation.

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

Childhood vaccinations and immunisations

5

(1) A provider whose agreement includes the provision of childhood vaccinations and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The provider shall–

(a) offer to provide to children all vaccinations and immunisations (excluding childhood vaccinations and immunisations) of a type and in the circumstances for which a fee was provided for under the 2003-04 Statement of Fees and Allowances made under regulation 35 (payments) of the National Health Service (General Medical Services) (Scotland) Regulations 1995;

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

(c) record in the patient’s record kept in accordance with paragraph 33 of Schedule 1 any refusal of the offer referred to in paragraph (a);

(d) where the offer is accepted, administer the vaccinations and immunisations and include in the patient’s record kept in accordance with paragraph 33 of Schedule 1–

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

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

(iii) the date of administration;

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

(v) any contraindications to the vaccination or immunisation; and

(vi) any adverse reactions to the vaccination or immunisation.

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

Child health surveillance

6

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

(a) provide all the services described in sub-paragraph (2), other than any examination so described which the parent refuses to allow the child to undergo, until the date upon which the child attains the age of 5 years; and

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

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

(a) the monitoring–

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

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

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

(b) the examination of the child at a frequency that has been agreed with the Health Board in accordance with the nationally agreed evidence based programme set out in the fourth edition of “Health for all Children”[^f00085].

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

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

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

Maternity medical services

7

(1) A provider whose agreement includes the provision of maternity medical services shall provide–

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

(b) to female patients and their babies all necessary maternity medical services throughout the postnatal period other than neonatal checks;

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

(2) In this paragraph–

“antenatal period” means the period from the start of the pregnancy to the onset of labour;

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

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

Minor surgery

8

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

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

(a) curettage;

(b) cautery; and

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

SCHEDULE 4 — AGREEMENTS TO PROVIDE OUT OF HOURS SERVICES

Criteria for out of hours services

1

A provider shall only be required to provide out of hours services if, in the reasonable opinion of the provider in 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 the patient could obtain such services during core hours.

Standards for out of hours services

2

From 1st January 2005, a provider which provides out of hours services must, in the provision of such services, meet the quality standards set out from time to time in guidance which has been issued to Health Boards by NHS Quality Improvement Scotland and notified in writing to the provider by the Health Board.

Agreements to provide essential services and out of hours services

3

A provider who is required under the agreement to provide essential services and out of hours services, shall provide throughout the out of hours period the essential services which must be provided in core hours under the agreement and such additional services as are included in the agreement.

Sub-contracting out of hours service

4

(1) A provider shall not, otherwise than in accordance with the written approval of the Health Board, sub-contract all or part of the provider’s duty to provide out of hours services to any person other than those listed in sub-paragraph (2), other than on a short-term occasional basis.

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

(a) a person who holds a general medical services contract with a Health Board which includes the provision of the equivalent of essential services during all or part of the out of hours period;

(b) a provider who is required to provide the equivalent of essential services to his patients during all or part of the out of hours period;

(c) a health care professional, not falling within paragraph (a) or (b), who is to provide the out of hours services personally under a contract for services; or

(d) a group of medical practitioners, whether in partnership or not, who provide out of hours services for each other under informal rota arrangements.

(3) An application for approval under sub-paragraph (1) shall be made by the provider in writing to the Health Board and shall state–

(a) the name and address of the proposed sub-contractor;

(b) the address of any premises used for the provision of services;

(d) the services to be covered by the arrangement; and

(e) how it is proposed that the sub-contractor will meet the provider’s obligations under the agreement in respect of the services covered by the arrangement.

(4) Within 7 days of receipt of an application under sub-paragraph (3), a Health Board may request such further information relating to the proposed arrangements as seem to it to be reasonable.

(5) Within 28 days of receipt of an application which meets the requirements specified in sub paragraph (3), the Health Board shall–

(a) approve the application;

(b) approve the application with conditions; or

(6) The Health Board shall not refuse the application if it is satisfied that the proposed arrangement will, in respect of the services to be covered, enable the provider to meet satisfactorily its obligations under the contract and will not–

(a) put at serious risk the safety of the provider’s patients;

(b) put the Board at risk of material financial loss.

(7) The Health Board shall inform the provider by notice in writing of its decision on the application and, where it refuses an application, it shall include in the notice a statement of the reasons for its refusal.

(8) Where a Health Board approves a sub-contract under this paragraph the Health Board and the provider shall be deemed to have agreed a variation of the agreement which has the effect of adding to the list of practice premises for the purposes of the provision of services in accordance with that application, any premises whose address was notified to it under sub-paragraph (3)(b) and paragraph 59 of Schedule 1 shall not apply.

(9) Sub-paragraphs (1) to (8) shall also apply in relation to any renewal or material variation of a sub-contract in relation to out of hours services.

(10) A contract with a sub-contractor must prohibit the sub-contractor from sub-contracting the out of hours services it has agreed with the provider to provide.

Withdrawal and variation of approval under paragraph 4

5

(1) Without prejudice to any other remedies which it may have under the agreement, where a Health Board has approved an application made under paragraph 4 it shall, subject to paragraph 6, be entitled to serve notice on the provider withdrawing or varying that approval from a date specified in the notice if it is no longer satisfied that the proposed arrangement will enable the provider to meet satisfactorily its obligations under the agreement.

(2) The date specified in the notice shall be such as appears reasonable in all the circumstances to the Health Board.

(3) The notice referred to in sub-paragraph (1) shall take effect on whichever is the later of–

(a) the date specified in the notice; or

(b) (if applicable) the date of the final determination of the NHS dispute resolution procedure (or any court proceedings) relating to the notice in favour of the Health Board.

Withdrawal and variation of approval under paragraph 4

6

(1) Without prejudice to any other remedies which it may have under the agreement, where a Health Board has approved an application made under paragraph 4(3) it shall be entitled to serve notice on the provider withdrawing or varying that approval with immediate effect if–

(a) it is no longer satisfied that the proposed arrangement will enable the provider to meet satisfactorily its obligations under the agreement; and

(b) it is satisfied that immediate withdrawal or variation is necessary to protect the safety of the provider’s patients.

(2) An immediate withdrawal of approval under sub-paragraph (1) shall take effect on the date on which the notice referred to in that sub-paragraph is received by the provider.

Temporary arrangements for transfer of obligations and liabilities in relation to certain out of hours services

7

(1) In this paragraph and in paragraphs 8 to 11–

“out of hours arrangement” means an arrangement under sub-paragraph (2); and

“transferee out of hours services provider” means a person referred to in sub paragraph (5) who has undertaken to carry out the obligations of a provider during all or part of the out of hours period in accordance with an out of hours arrangement referred to in sub paragraph (2).

(2) Subject to the provisions of this Schedule, where a provider is required to provide out of hours services pursuant to regulation 26, the provider may, with the approval of the Health Board, make an arrangement with a person referred to in sub paragraph (5) to transfer the provider’s obligations under these Regulations.

(3) Any arrangement made pursuant to sub paragraph (2) shall cease to have effect–

(a) on the day when the transferee out of hours service provider ceases to meet any of the conditions required to provide primary medical services under these Regulations; or

(b) on 1st January 2005,

whichever is the earlier.

(4) An arrangement made in accordance with sub paragraph (2) shall, for so long as it continues, relieve the provider of–

(a) its obligations to provide out of hours services pursuant to regulation 26; and

(b) all liabilities under the agreement in respect of those services.

(5) The person referred to in this sub paragraph is any person who holds a general medical services contract or an agreement with the Health Board which includes the provision of out of hours services.

(6) A provider may make more than one out of hours arrangement and may do so (for example) with different general medical services contractors or providers and in respect of different patients, different times and, where the provider has a provider’s list of patients, different parts of its practice area.

(7) Nothing in this paragraph prevents a provider from retaining or resuming its obligations in relation to named patients.

Application for approval of an out of hours arrangement

8

(1) An application to the Health Board for approval of an out of hours arrangement shall be made in writing and shall state–

(a) the name and address of the proposed transferee out of hours service provider;

(b) the periods during which the provider’s obligations under the agreement are to be transferred;

(c) how the proposed transferee out of hours service provider intends to meet the provider’s obligations during the periods specified under paragraph (b);

(d) the arrangements for the transfer of the provider’s obligations under the agreement to and from the transferee out of hours service provider at the beginning and end of the periods specified under paragraph (b); and

(e) how long the proposed arrangements are intended to last and the circumstances in which the provider’s obligations under the agreement during the periods specified under paragraph (b) would revert to it.

(2) The Health Board shall determine the application before the end of the period of 28 days beginning with the day on which the Health Board received it.

(3) The Health Board shall grant approval to a proposed out of hours arrangement if it is satisfied–

(a) having regard to the overall provision of primary medical services provided in the out of hours period in its area, that the arrangement is reasonable and will contribute to the efficient provision of such services in the area;

(b) having regard, in particular, to the interests of the provider’s patients, that the arrangement is reasonable;

(c) having regard, in particular, to all reasonably foreseeable circumstances, that the arrangement is practicable and will work satisfactorily;

(d) that it will be clear to the provider’s patients how to seek primary medical services during the out of hours period; and

(e) that if the arrangement comes to an end, the provider has in place proper arrangements for the immediate resumption of the provider’s responsibilities,

and shall not refuse to grant approval without first consulting the area medical committee for its area.

(4) The Health Board shall give notice to the provider of its determination and, where it refuses an application, it shall send the provider a statement in writing of the reasons for its determination.

(5) A provider which wishes to refer the matter in accordance with the NHS dispute resolution procedure must do so before the end of the period of 30 days beginning with the day on which the Health Board’s notification under sub paragraph (4) was sent.

Effect of approval of an arrangement with a transferee out of hours service provider

9

Where the Health Board has approved an out of hours arrangement with a transferee out of hours service provider, the Health Board and the transferee out of hours service provider shall be deemed to have agreed a variation of their agreement or general medical services contract which has the effect of including in it, from the date on which the out of hours arrangement commences, and for so long as that arrangement continues, the services covered by that arrangement and paragraph 59(1) of Schedule 1 to these Regulations or paragraph 94(1) of Schedule 5 to the GMS Contracts Regulations (as the case may be) shall not apply.

Review of approval

10

(1) Where it appears to the Health Board that it may no longer be satisfied of any of the matters referred to in paragraph 8(3), it may give notice to the provider that it proposes to review its approval of the out of hours arrangement.

(2) On any review under sub paragraph (1), the Health Board shall allow the provider a period of 30 days, beginning with the day on which it sent the notice, within which to make representations in writing to the Health Board.

(3) After considering any representations made in accordance with sub-paragraph (2), the Health Board may determine to–

(a) continue its approval;

(b) withdraw its approval following a period of notice; or

(c) if it appears to it that it is necessary in the interests of the provider’s patients, withdraw its approval immediately.

(4) Except in the case of an immediate withdrawal of approval, the Health Board shall not withdraw its approval without first consulting the area medical committee for its area.

(5) Where the Health Board determines to withdraw its approval immediately, it shall notify the area medical committee for its area.

(6) The Health Board shall give notice to the provider of its determination under sub paragraph (3).

(7) Where the Health Board withdraws its approval, whether immediately or on notice, it shall include with the notice a statement in writing of the reasons for its determination.

(8) A provider which wishes to refer the matter in accordance with the NHS dispute resolution procedure must do so before the end of the period of 30 days beginning with the day on which the Health Board’s notification under sub paragraph (6) was sent.

(9) Where the Health Board determines to withdraw its approval following a period of notice, the withdrawal shall take effect at the end of the period of two months beginning with—

(a) the date on which the notice referred to in sub paragraph (6) was sent; or

(b) where there has been a dispute which has been referred under the NHS dispute resolution procedure and the dispute is determined in favour of withdrawal, the date on which the provider receives notice of the determination.

(10) Where the Health Board determines to withdraw its approval immediately, the withdrawal shall take effect on the day on which the notice referred to in sub paragraph (6) is received by the provider.

Immediate withdrawal of approval other than following review

11

(1) The Health Board shall withdraw its approval of an out of hours arrangement immediately–

(a) in the case of an arrangement with a person referred to in paragraph 7(5), if the person with whom it is made ceases to hold a general medical services contract or an agreement with the Health Board which includes the provision of out of hours services; or

(b) where, without any review having taken place under paragraph 10, it appears to the Health Board that it is necessary in the interests of the provider’s patients to withdraw its approval immediately.

(2) The Health Board shall give notice to the provider of a withdrawal of approval under sub paragraph (1)(a) or (b) and shall include with the notice a statement in writing of the reasons for its determination.

(3) An immediate withdrawal of approval under sub paragraph (1) shall take effect on the day on which the notice referred to in sub paragraph (2) is received by the provider.

(4) The Health Board shall notify the area medical committee for its area of a withdrawal of approval under sub paragraph (1)(b).

(5) A provider which wishes to refer a withdrawal of approval under sub paragraph (1)(b) in accordance with the NHS dispute resolution procedure must do so before the end of the period of 30 days beginning with the day on which the Health Board’s notification under sub paragraph (2) was sent.

SCHEDULE 5

CLOSURE NOTICE

SCHEDULE 6 — INFORMATION TO BE INCLUDED IN PRACTICE LEAFLETS

A practice leaflet shall include–

1

The name(s) of the provider.

2

In the case where a partnership is a party to the agreement–

(a) whether or not it is a limited partnership; and

(b) the names of all the partners and, in the case of a limited partnership, their status as a general or limited partner.

3

In the case where a company is a party to the agreement–

(a) the names of the directors, the company secretary and the shareholders of that company; and

(b) the address of the company’s registered office.

4

The full name of each person performing services under the agreement.

5

In the case of each health care professional performing services under the agreement the health care professional’s professional qualifications.

6

Whether the provider undertakes the teaching or training of health care professionals or persons intending to become health care professionals.

7

The provider’s practice area, by reference to a sketch diagram, plan or postcode.

8

The address of each of the practice premises.

9

The provider’s telephone and fax number and the address of the provider’s website (if any).

10

Whether the practice premises have suitable access for all disabled patients and, if not, the alternative arrangements for providing services to such patients.

11

Where the provider provides essential services, how to register a patient.

12

The right of patients to express a preference of practitioner in accordance with paragraph 8 of Schedule 1 and the means of expressing such a preference.

13

The services available under the agreement.

14

The opening hours of the practice premises and the method of obtaining access to services throughout the core hours.

15

The criteria for home visits and the method of obtaining such a visit.

16

Where the provider provides essential services, the consultations available to patients under paragraphs 5 and 6 of Schedule 2.

17

Where the provider provides essential services, the arrangements for services in the out of hours period (whether or not provided by the provider) and how the patient may contact such services.

18

If the services in paragraph 17 are not provided by the provider, the fact that the Health Board referred to in paragraph 27 is responsible for commissioning the services.

19

The telephone number of NHS 24 and details of the NHS 24 website.

20

The method by which patients are to obtain repeat prescriptions.

21

If the provider is a dispensing provider the arrangements for dispensing prescriptions.

22

How patients may make a complaint or comment on the provision of service.

23

The rights and responsibilities of the patient, including keeping appointments.

24

The action that may be taken where a patient is violent or abusive to the provider or the provider’s staff, persons present on the practice premises, or in the place where treatment is provided under the agreement, or other persons specified in paragraph 8(2)(c) of Schedule 1 or paragraph 15(2) of Schedule 2.

25

Details of who has access to patient information (including information from which the identity of the individual can be ascertained) and the patient’s rights in relation to disclosure of such information.

26

The name, address and telephone number of the Health Board which is a party to the agreement and from whom details of primary medical services in the area may be obtained.

Signed

MALCOLM CHISHOLM — A member of the Scottish Executive — 10th March 2004

Explanatory note

(This note is not part of the Regulations)

These Regulations set out, for Scotland, the framework for section 17C agreements for primary medical services under section 17C of the National Health Service (Scotland) Act 1978 (“the Act”).

Part 2 of the Regulations prescribes the conditions which, in accordance with section 17D of the Act, must be satisfied by a medical practitioner, health care professional or any of the other persons listed in 17D(1)(b)(iii) to (ix), (d) or (e) of the Act for a Health Board to be able to make an agreement under section 17C under which primary medical services are provided.

Part 3 of the Regulations prescribes the procedure for pre-agreement dispute resolution, in accordance with section 17E(3D) of the Act.

Part 4 of the Regulations sets out the circumstances and the extent to which the provider under an agreement may be treated as a health service body.

Part 5 of the Regulations (and Schedules 1 to 4) prescribe the categories of primary medical services that may be provided in accordance with section 17C arrangements, and make provision with respect to the provision of those services. The regulations require agreements which include the provision of any primary medical services to contain the terms in Schedule 1, agreements which include the provision of essential services to include the terms in Schedule 2, agreements which include the provision of additional services to include terms set out in Schedule 3 and agreements which include the provision of out of hours services to include the terms set out in Schedule 4

Part 6 makes additional provision with respect to such agreements and their content, including provision as to the effect on an agreement of a change in the membership of a partnership that is party to it (regulation 17), services generally (regulation 18), certificates (regulation 19), finance and payments for the provision of services to be made in accordance with the directions of the Scottish Ministers (regulation 20 and 21), and fees and charges (regulation 22).

Part 7 prescribes additional functions to be exercised by area medical committees in relation to section 17C agreements.

Part 8 of the Regulations makes provision requiring a Health Board in certain circumstances and subject to certain conditions, to enter into a general medical services contract with a person providing services under section 17C arrangements.

Part 9 of the Regulations makes transitional provision.

Schedule 1 sets out terms that must be contained in all section 17C agreements for primary medical services. These include terms relating to–

(a) the provision of services (Part 1);

(b) the right of patients to choose the persons from whom they are to receive primary medical services, and the circumstances in which providers may decline responsibility for patients not registered with them (Part 2);

(d) the conditions (including conditions as to qualifications and experience) to be satisfied by persons performing primary medical services in accordance with section 17C arrangements (Part 4);

(e) patient records, the provision of information and rights of entry (Part 5);

(f) complaints (Part 6);

(g) procedures for the determination of disputes where the provider is to be treated as a health service body, or where the provider elects (Part 7); and

(h) the variation and termination of section 17C arrangements and provision for participants other then Health Boards to withdraw from section 17C arrangements if they wish to do so (Part 8).

Schedule 2 sets out the terms that must be contained in all section 17C agreements which include the provision of essential services. These include terms relating to–

(a) the provision of essential services ; and

(b) lists of patients, and the circumstances in which the provider must or may accept or may decline to accept a person as a patient and may terminate responsibility a patient.

Schedule 3 sets out the terms relating to the provision of additional services that must be included in all agreements for the provision of those services.

Schedule 4 sets out the terms relating to the provision of out of hours services, and the sub contracting of those services, that must be included in all agreements for the provision of those services.

Footnotes

[^f00001]: 1978 c. 29; section 17D was inserted by the National Health Service (Primary Care) Act 1997 (c. 46) (“the 1997 Act”), section 21(2) and amended by the Primary Medical Services (Scotland) Act (asp 1) (“the 2004 Act”), section 2(3); section 17E was inserted by the 1997 Act, section 22(2) and amended by the Health Act 1999 (c. 8), Schedule 4, paragraph 47 and the 2004 Act, section 2(4); section 28 was amended by the National Health Service (Amendment) Act 1986 (c. 66), section 3(4) and the National Health Service and Community Care Act 1990 (c. 19) Schedule 9, paragraph 19(8); section 105(7) was amended by the Health Services Act 1980 (c. 53), type=start time=1185527916157Schedule 6type=end time=1185527916157, paragraph 5 and by type=start time=1185527948423the Health and Social Services and Social Security Adjudications Acttype=end time=1185527948423 1983 (c. 41), Schedule 7, paragraph 24; section 108(1) defines “prescribed” and “regulations”. The functions of the Secretary of State were transferred to the Scottish Ministers by virtue of section 53 of the Scotland Act 1998 (c. 46).

[^f00002]: 2004 asp 1.

[^f00003]: S.I. 2003/1250.

[^f00004]: Section 17C was inserted by the National Health Service (Primary Care) Act 1997 (c. 46), section 21(2) and was amended by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 2(2).

[^f00005]: Section 27 was amended by the National Health Service and Community Care Act 1990 (c. 19), Schedule 9, the Medicine Products: Prescription by Nurses etc. Act 1992 (c. 28), section 3, type=start time=1185528129831the National Health Service (Primary Care) Acttype=end time=1185528129831 1997 (c. 46), Schedule 2, paragraph 44, the Health and Social Care Act 2001 (c. 15), section 44 and S.I. 2003/1590.

[^f00006]: 1983 c. 54; section 11(4) was amended by the National Health Service (Primary Care) Act 1997 (c. 46), section 35(4) type=start time=1185528155644and Schedule 2type=end time=1185528155644, paragraph 61(2).

[^f00007]: 1977 c. 49.

[^f00008]: S.I. 1978/1907 (N.I. 26).

[^f00009]: Section 17J was inserted by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 4.

[^f00010]: S.S.I. 2004/115.

[^f00011]: S.I. 1998/5 as amended by S.I. 1998/669 and S.S.I. 2000/23.

[^f00012]: S.I. 1972/1265 (N.I. 14).

[^f00013]: S.I. 1991/194 (N.I. 1).

[^f00014]: Section 17D(2) was inserted by the National Health Service (Primary Care) Act 1997 (c. 46), section 21(2) and was amended by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 23(d) and schedule, paragraph 1(3).

[^f00015]: Section 17A(2) was inserted by the National Health Service and Community Care Act 1990 (c. 19), section 30 and amended by the Health Authorities Act 1995 (c. 17)type=start time=1185528201223,type=end time=1185528201223 Schedule 1, paragraph 102(2), the National Health Service (Primary Care) Act 1997 (c. 46), Schedule 2, paragraph 36, the Health Act 1999 (c. 8), Schedule 4, paragraph 46 and S.I. 1991/195.

[^f00016]: 1995 c. 36 .

[^f00017]: 1968 c. 67.

[^f00018]: 1907 c. 24.

[^f00019]: Section 29(8) was substituted by the Health Act 1999 (c. 8), section 58(1) and amended by the Community Care and Health (Scotland) Act 2002 type=start time=1185528225786(asp 5)type=end time=1185528225786, Schedule 2, paragraph 2(4)(b) and the Primary Medical Services (Scotland) Act 2004 (asp 1), section 5(3).

[^f00020]: 1977 c. 49. type=start time=1185528255552Section 16BAtype=end time=1185528255552 was inserted by the National Health Service Reform and Health Care Professions Act 2002 (c. 17), section 6.

[^f00021]: Section 29B(2) was inserted by the Health Act 1999 (c. 8), section 58 and amended by the Community Care and Health (Scotland) Act 2002 (asp 5), schedule 2, paragraph 2 and the Primary Medical Services (Scotland) Act 2004 (asp 1), schedule, paragraph 1(13).

[^f00022]: 1983 c. 54; section 2 was amended by S.I. 1996/1591 and 2002/3135.

[^f00023]: 2003 c. 43.

[^f00024]: 1990 c. 19.

[^f00025]: S.I. 2002/253.

[^f00026]: S.I. 1995/414 as amended by S.I. 1996/840 and 1504, 1997/696, 1998/2224 and 3031 and S.S.I. 1999/57, 2001/70, 2002/111 and 153, 2003/296.

[^f00027]: 1968 c. 67.

[^f00028]: type=start time=1185528305318Section 69type=end time=1185528305318 was amended by the Statute Law (Repeals) Act 1993 (c. 50) and type=start time=1185528325475the Pharmacists (Fitness to Practise) Acttype=end time=1185528325475 1997 (c. 19), Schedule 4, paragraph 5.

[^f00029]: S.I. 1997/1830 as amended by S.I. 1997/2044, type=start time=11855283931941998/108type=end time=1185528393194, type=start time=11855284219761178type=end time=1185528421976 and 2081, 1999/1044 and 3463, type=start time=11855284428982000/1917type=end time=1185528442898, 2889 and 3231, type=start time=11855284597262001/2777type=end time=1185528459726, 2889 and 3942, 2002/549 and 2469 and 2003/696.

[^f00030]: 1977 c. 49. Section 16A was inserted by the Health Act 1999 (c. 8), section 2(1).

[^f00031]: Section 17P was inserted by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 5(2).

[^f00032]: 1954, c. 61.

[^f00033]: S.I. 1976/1213.

[^f00034]: Section 17N was inserted by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 4.

[^f00035]: 1978, c. 29. Section 17D(1) was inserted by the National Health Service (Primary Care) Act 1997 (c. 46), section 21(2) and amended by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 2(3).

[^f00036]: 1995 c. 46.

[^f00037]: 1933 c. 12 as amended by the Sexual Offences Act 1956 (c. 69), sections 48 and 51 and Schedules 3 and 4 and the Criminal Justice Act 1988 (c. 33) (“the 1988 Act”), section 170, Schedule 15, paragraph 8 and Schedule 16, paragraph 16; and as modified by the 1988 Act, section 170(1) Schedule 15, paragraph 9.

[^f00038]: 1986 c. 45. Schedule 4A was inserted by section 257 of and Schedule 20 to the Enterprise Act 2002 (c. 40).

[^f00039]: 1990 c. 40.

[^f00040]: type=start time=11855285321021986 c. 46type=end time=1185528532102.

[^f00041]: S.I. 1986/1032 (N.I. 6).

[^f00042]: type=start time=11855292547361986 c. 45type=end time=1185529254736 as amended by the Insolvency Act 2000 (c. 39).

[^f00043]: Section 17D(3) was inserted by the Primary Medical Services (Scotland) Act type=start time=11855293443312004type=end time=1185529344331 (asp 1), section 2(3)(e).

[^f00044]: 1978, c. 29. Section 17A was inserted by the National Health Service and Community Care Act 1990 (c. 19), section 30 and amended by the Health Authorities Act 1995 (c. 17)type=start time=1185529377425,type=end time=1185529377425 Schedule 1, paragraph 102(2), the National Health Service (Primary Care) Act 1997 (c. 46), Schedule 2, paragraph 36, the Health Act 1999 (c. 8), Schedule 4, paragraph 46 and S.I. 1991/195.

[^f00045]: S.I. 1976/615. Relevant amending instruments are S.I. 1982/699, type=start time=11855294182391992/247type=end time=1185529418239, 1994/2975, 1995/987 and type=start time=11855294579272000/590type=end time=1185529457927.

[^f00046]: 1978 c. 29. Section 17E(3A) was inserted by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 2(4)(c).

[^f00047]: Section 2(5) was amended by the National Health Service and Community Care Act 1990 (c. 19), Schedule 9, paragraph type=start time=118552952916219(1)type=end time=1185529529162.

[^f00048]: Section 17L was inserted by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 4.

[^f00049]: S.S.I. 2001/72.

[^f00050]: 1995, c. 36.

[^f00051]: 2000 asp 4.

[^f00052]: 1971 c. 38.

[^f00053]: S.I. 2001/3998. Schedule 4 was amended by S.I. 2003/1432.

[^f00054]: Section 17N was inserted by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 4.

[^f00055]: Article 3B was inserted into the POM Order by S.I. 2003/696.

[^f00056]: 1968 c. 67.

[^f00057]: 1972 c. 68.

[^f00058]: O.J. L 311, 28.11.2001, p.67.

[^f00059]: S.S.I. 2001/430, as amended by S.S.I. 2002/100 and 2003/130 and 295.

[^f00060]: S.S.I. 2003/460.

[^f00061]: 1968 c. 67.

[^f00062]: 1983 c. 54. Section 41A was inserted by S.I. 2000/1803.

[^f00063]: 1983 c. 54. Section 15 was amended by the National Health Service (Primary Care) Act 1997 (c. 46) (“the 1997 Act”), type=start time=1185529610053Schedule 2type=end time=1185529610053, Part 1, paragraph type=start time=118552964046061(4)type=end time=1185529640460; section 15A was inserted by S.I. 2000/3041; section 21 was amended by the 1997 Act, type=start time=1185529615319Schedule 2type=end time=1185529615319, Part 1, paragraph 61(5) and by S.I. 1996/1591 and 2002/3135.

[^f00064]: The current guidance is the GP Registrar Scheme Vocational Guide for General Medical practice – the UK Guide 2000 published by the Department of Health and available on their website at or by writing to the Department of Health, P.O. Box 777, London SE1 6XH.

[^f00065]: Copies of NHS Circular PCA(M)(2001)17 may be obtained in writing from the Scottish Executive Health Department, Primary Care Division, St. Andrew’s House, Regent Road, Edinburgh EH1 3DG.

[^f00066]: RFA V.1 is published on Scottish Health on the Web (SHOW) at the following link: http;//www.show.scot.nhs.uk/publications/me/gpcomputerrecords/rfav1.pdf.

[^f00067]: 1978 c. 29. Section 2(5) was amended by the National Health Service and Community Care Act 1990 (c. 19), type=start time=1185529947433Schedule 9, paragraph 19(1)type=end time=1185529947433.

[^f00068]: Section 2C was inserted into the Act by the Primary Medical Services (Scotland) Act 2004 (asp 1), section 1(2).

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