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The National Health Service (General Medical Services) Regulations 1992

Type Statutory-Instrument

Publication 1992-03-10

State In force

Department Queen's Printer of Acts of Parliament

Source legislation.gov.uk

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Reform history JSON API

a doctor’s obligations under the terms of service are not being adequately carried out, it may, after consultation with the Local Medical Committee and with the consent of the Secretary of State, make arrangements for the temporary provision of general medical services for that doctor’s patients which may consist of or include the appointment of one or more doctors to undertake the treatment of such persons, and may vary such arrangements as necessary.

(7) Subject to paragraph (10), arrangements under paragraph (6) shall subsist for such period as the FHSA may determine, but not, in a case to which paragraph (6)(a) applies, beyond the date (if any) on which the FHSA is satisfied, after consulting the Local Medical Committee, that the doctor is fit to resume his practice.

(8) Before varying or terminating any arrangements made under paragraph (6), but after consulting the Local Medical Committee, the FHSA may require the doctor to be medically examined.

(9) Where under paragraph (5) or (8) a doctor is required to be medically examined—

(a) he shall submit himself for medical examination by a doctor appointed by the Local Medical Committee; and

(b) the Local Medical Committee, having considered the report of the examining doctor, shall make a report in writing to the FHSA as to the doctor’s fitness to carry out his obligations under the terms of service.

(10) Where the FHSA proposes that the arrangements under paragraph (2) or (6) shall continue—

(a) for longer than one year;

(b) for such shorter period as the Secretary of State may specify in any particular case; or

it shall so notify the Secretary of State in writing not less than 30 days, or as soon as is practicable, before the expiry of that period or further period and shall, in each case, obtain the consent of the Secretary of State to the continuance of the arrangements.

(11) The FHSA shall—

(a) give reasonable notice in writing of the termination of arrangements under paragraph (2) or (6) to the doctor with whom they were made; and

(b) as soon as is practicable, notify the Secretary of State in writing that such termination has taken place.

(12) The FHSA shall, where practicable, notify in writing any doctor for the treatment of whose patients arrangements are made under this regulation of such arrangements and of their variation or termination.

(13) A doctor appointed under this regulation shall agree in writing to be bound throughout his appointment by the terms of service which were applicable to the doctor the treatment of whose patients he is appointed (with or without other doctors) to undertake, except that nothing in this regulation shall require him to provide child health surveillance services, contraceptive services, maternity medical services or minor surgery services which he has not undertaken to provide.

(14) Any person on the list of the doctor for the treatment of whose patients arrangments are made under this regulation shall be deemed to remain on that list while those arrangements subsist, unless that person is transferred to the list of another doctor, and any person who applies to the doctor appointed under this regulation for acceptance shall, if accepted, be recorded by the FHSA as being—

(a) where that doctor is included in the medical list by virtue of regulation 4(1)(a), on his list; and

(b) in any other case, on the list of the doctor for the treatment of whose patients arrangements are made under this regulation.

(15) The FHSA—

(a) may deduct from the remuneration of a doctor—

(i) for the treatment of whose patients arrangements are made under paragraph (6), or

(ii) consequent upon the suspension of whose registration arrangements are made under paragraph (2)(a),

the cost, in whole or in part, of any such arrangements; and

(b) in the case of a doctor performing relevant service, shall deduct from his remuneration the cost of any such arrangements.

(16) In the application of the Act to the making of arrangements for the temporary provision of general medical services and the provision of such services in pursuance of those arrangements—

(a) section 29(4) (which prohibits, with exceptions, payment of a fixed salary) shall have effect as if the words “otherwise than temporarily” were inserted after the words “general medical services”; and

(b) section 30(1A) (which contains requirements as to knowledge of English) shall apply to a doctor appointed under this regulation, and in respect of any such doctor section 30(1A) shall have effect as if for the words from “shall be entitled” to “referred to the Medical Practices Committee” there were substituted the words “shall be appointed to provide general medical services temporarily” and as if the words “and where” to the end of the subsection were omitted.

Temporary residents

26

(1) A person requiring treatment who—

(a) is not on the list of a doctor providing general medical services in the area of the locality where he is temporarily residing;

(b) normally resides in a school or similar institution in the locality but is temporarily residing at home in that locality;

(d) is moving from place to place and is not for the time being resident in any place,

may apply to any doctor providing services in the locality in which he is temporarily resident to be accepted by him as a temporary resident.

(2) For the purposes of paragraph (1), a person shall be regarded as temporarily resident in a place if, when he arrives in that place, he intends to stay there for more than 24 hours but not more than 3 months.

(3) Subject to paragraph (4), a person mentioned in sub-paragraph (a), (b) or (c) of paragraph (1) who is accepted as a temporary resident shall not be removed from the list of any doctor in which he is already included.

(4) If the FHSA for the locality in which the temporary resident is included in any doctor’s list is satisfied, after due enquiry—

(a) that his stay in the locality of temporary residence has exceeded 3 months; and

(b) that he has not returned to that FHSA’s locality,

it shall thereupon remove him from that doctor’s list and, if practicable, inform him of that fact and of his entitlement to seek acceptance by any doctor, including the doctor by whom he has been treated as a temporary resident, in the locality in which he is living, and of the name and address of the FHSA for that locality.

PART V — CHILD HEALTH SURVEILLANCE SERVICES, CONTRACEPTIVE SERVICES, MATERNITY MEDICAL SERVICES AND MINOR SURGERY SERVICES

Child health surveillance list

27

(1) The FHSA shall maintain a list (in these Regulations referred to as “a child health surveillance list”) of the names of those doctors who have satisfied the FHSA or, on appeal, the Secretary of State, in accordance with the following provisions of this regulation, that they have such medical experience and training as are necessary to enable them properly to provide child health surveillance services.

(2) A doctor may apply, in accordance with paragraph (3), to the FHSA for the inclusion of his name in the child health surveillance list required to be maintained by that FHSA.

(3) An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part VIII of Schedule 3 to these Regulations.

(4) Unless the doctor otherwise agrees, the FHSA shall determine an application made in accordance with paragraph (3) within 2 months of receiving it.

(5) The FHSA may, if it thinks fit, hold an oral hearing of any application and shall not refuse an application without giving the doctor an opportunity of an oral hearing.

(6) Where the FHSA decides to hold an oral hearing, it shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the doctor.

(7) When determining an application the FHSA shall have regard in particular to—

(a) any post-graduate qualification held by him; and

(b) any training undertaken by the doctor and any medical experience gained by him, during the period of five years immediately preceding the date of the application,

which is relevant to the provision of child health surveillance services, and shall seek and take into account any medical advice it considers necessary to enable it to determine the application.

(8) The FHSA shall determine an application by either—

(a) granting the application; or

(b) refusing the application.

(9) The FHSA shall give notice in writing to the doctor of its determination and shall—

(a) where it refuses the application, inform him of the reasons for the determination and of his right of appeal under paragraph (10);

(b) where it grants the application, include the doctor’s name in its child health surveillance list.

(10) If an application is refused the doctor may appeal in writing to the Secretary of State within 30 days of receiving notice in writing of the FHSA’s determination.

(11) On any appeal pursuant to paragraph (10) or (16), the Secretary of State—

(a) may, if he thinks fit, hold an oral hearing of the appeal and, in such a case, shall—

(i) appoint one or more persons to hear the appeal who shall report to him on the appeal, and

(ii) not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the FHSA;

(b) in determining the appeal, shall either confirm or reverse the determination of the FHSA and shall communicate his decision, together with the reasons for it, to the appellant and to the FHSA;

(c) where he reverses the determination of the FHSA, shall direct that the FHSA include the doctor’s name in its child health surveillance list.

(12) Subject to paragraphs (13) to (17), a doctor’s name may be removed by the FHSA from the child health surveillance list only if—

(a) it has been removed from the medical list of any FHSA pursuant to regulation 6(3) or regulation 7; or

(b) the FHSA has determined that the doctor has not provided child health surveillance services at any time during the past 5 years;

(13) Before making any determination under sub-paragraph (b) of paragraph (11) the FHSA shall—

(a) give the doctor 30 days' written notice of its intention to do so; and

(b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the FHSA.

(14) Where the FHSA makes a determination under sub-paragraph (b) of paragraph (12), it shall send to the doctor a notice which shall include a statement—

(a) to the effect that, subject to any appeal under paragraph (15), the doctor’s name will, after 30 days from the date of the notice, be removed from the child health surveillance list maintained by the FHSA;

(b) of the FHSA’s reasons for its determination; and

(15) A doctor who has received a notice sent in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Secretary of State against the determination of the FHSA, and pending the determination of the appeal, the FHSA shall not remove his name from the child health surveillance list.

(16) An appeal to the Secretary of State shall be made in writing and shall include a statement of the grounds of appeal and on any such appeal the Secretary of State shall, if he allows the appeal, direct that the FHSA shall not remove the doctor’s name from the child health surveillance list.

(17) The FHSA shall comply with any direction given to it under this regulation.

(18) Where the Secretary of State holds an oral hearing of an appeal pursuant to paragraph (11), the appellant and the FHSA may be represented by counsel, solicitor or any other person.

Obtaining child health surveillance services

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(1) A parent may, in relation to a child of his who is under the age of 5 years, apply to a doctor—

(a) who is—

(i) the doctor on whose list the child is included (in this paragraph referred to as “the child’s doctor”),

(ii) a doctor with whom the child’s doctor is in partnership, or

(iii) a doctor with whom the child’s doctor is associated in a group practice; and

(b) whose name is included in any medical list and in the child health surveillance list of the FHSA,

for the provision of child health surveillance services in respect of that child for a period ending on the date on which that child attains the age of 5 years.

(2) A doctor whose name is included in the medical list may, in respect of any person on his list or on the list of a doctor with whom he is in partnership or with whom he is associated in a group practice, undertake to provide child health surveillance services provided that—

(a) his name is also included in the child health surveillance list, and

(b) the person in question is a child who is under the age of 5 years.

(3) A doctor who has undertaken, pursuant to paragraph (2), to provide child health surveillance services to any child shall, in respect of that child—

(a) provide all the services described in paragraph 1 of Schedule 4 to these Regulations, 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;

(b) maintain such records as are specified in paragraph 2 of that Schedule; and

(c) furnish the relevant health authority with such information as is specified in paragraph 3 of that Schedule in accordance with the requirements of that paragraph.

(4) An undertaking to provide child health surveillance services shall cease forthwith to be effective if—

(a) either—

(i) the parent informs the doctor, or

(ii) the doctor informs the parent,

that he wishes the undertaking to have no further effect;

(b) the child has been removed from the doctor’s list, from that of his partner or from that of a doctor with whom he is associated in a group practice, as the case may be, and has not been transferred to any other of those lists;

(i) has been invited to arrange for the child to attend for an examination referred to in paragraph 1(b) of Schedule 4 to these Regulations, and

(ii) fails within 42 days to respond to that invitation; or

(d) any examination referred to in paragraph 1(b) of that Schedule is undertaken in respect of the child otherwise than by the doctor or a person acting on his behalf.

(5) Where in accordance with paragraph (4), an undertaking has ceased to be effective, the doctor shall forthwith—

(a) in a case to which any of heads (a), (c) or (d) of that sub-paragraph applies, so inform the FHSA in writing; and

(b) in a case to which head (c) or (d) of that sub-paragraph applies, also so inform the parent in writing.

Obtaining contraceptive services

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(1) Whether or not she is included in his list for the provision of other personal medical services, a woman may apply to a doctor who has undertaken to provide contraceptive services to be accepted by him for the provision of those services.

(2) An application under paragraph (2) shall be for the provision of such services for a period of 12 months from the date of acceptance, but either the woman or the doctor may terminate the provision at any time during that period.

(3) On any such termination or at the end of the period of 12 months, as the case may be, the woman may apply (or re-apply) to a doctor in accordance with paragraph (2).

(4) A woman may apply to a doctor who has undertaken to provide contraceptive services in a locality or part of a locality in which she is temporarily resident, to be accepted by him for the provision to her, as a temporary resident, of contraceptive services.

(5) Where a woman has been accepted by a doctor for the provision to her of contraceptive services under paragraph (4), paragraph 4 of regulation 26 shall apply to terminate that provision.

Obstetric list

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(1) The FHSA shall maintain a list (in these Regulations referred to as “the obstetric list”) of the names of—

(a) those doctors who, on 31st March 1992, were included in an obstetric list maintained by that FHSA; and

(b) those doctors who have satisfied the FHSA or, on appeal, the Secretary of State, in accordance with the following provisions of this regulation, that they have such medical experience and training as are necessary to enable them to be included in the obstetric list.

(2) A doctor may apply, in accordance with paragraph (3), to the FHSA for the inclusion of his name in the obstetric list maintained by that FHSA.

(3) An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part X of Schedule 3.

(4) Unless the doctor otherwise agrees, the FHSA shall determine an application made in accordance with paragraph (3) within 2 months of receiving it.

(5) Subject to paragraphs (6) and (7), the FHSA shall grant an application by a doctor for the inclusion of his name in the obstetric list where it is satisfied that the applicant has undertaken such training and has such experience relevant to the provision of maternity medical services as are sufficient to enable him to be included in the obstetric list.

(6) Before reaching any decision under paragraph (4), the FHSA—

(a) may hold an oral hearing and shall not decide to refuse an application without giving the doctor an opportunity of an oral hearing;

(b) shall have regard to whether or not the applicant satisfies one or more of the criteria set out in Schedule 5, Part I; and

(c) shall seek, and take into account, any medical advice it considers necessary to enable it to determine the application provided that where it seeks such advice, it shall consult the Local Medical Committee.

(7) Where the FHSA decides to hold an oral hearing, it shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the doctor.

(8) Where the FHSA is considering whether to grant an application in a case where the applicant satisfies none of the criteria set out in Schedule 5, Part I, it shall consult the Local Medical Committee.

(9) The FHSA shall determine an application by either—

(a) granting the application; or

(b) refusing the application.

(10) The FHSA shall inform the doctor in writing of its determination and shall—

(a) where it refuses the application, give notice in writing to him of the reasons for the determination and of his right of appeal under paragraph (11);

(b) where it grants the application, forthwith include the doctor’s name in its obstetric list.

(11) If an application is refused the doctor may appeal in writing to the Secretary of State within 30 days of receiving notice in writing of the FHSA’s determination.

(12) On any appeal pursuant to paragraph (11) or (16), the Secretary of State—

(a) may, if he thinks fit, hold an oral hearing of the appeal and in such a case shall—

(i) appoint one or more persons to hear the appeal who shall report to him on the appeal, and

(ii) not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the FHSA;

(b) in determining the appeal, shall either confirm or reverse the determination of the FHSA and shall communicate his decision, together with the reasons for it to the appellant and to the FHSA; and

(c) where he reverses the determination of the FHSA, he shall direct that the FHSA include the doctor’s name in its obstetric list.

(13) Subject to paragraphs (14) to (16), a doctor’s name may be removed from the obstetric list only if—

(a) it has been removed from the medical list of any FHSA pursuant to regulation 6(3) or 7; or

(b) the FHSA has determined that the doctor has not provided maternity medical services at any time during the past 5 years.

(14) Before making any determination under sub-paragraph (b) of paragraph (13) the FHSA shall—

(a) give the doctor 30 days' written notice of its intention to do so; and

(b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the FHSA.

(15) Where the FHSA makes a determination under sub-paragraph (b) ofparagraph (13), it shall send to the doctor a notice which shall include a statement—

(a) to the effect that, subject to any appeal under paragraph (15), the doctor’s name will, after 30 days from the date of the notice, be removed from the obstetric list maintained by the FHSA;

(b) of the FHSA’s reasons for its determination; and

(16) A doctor who has received a notice in accordance with paragraph (15) may, within 21 days of receiving it, appeal to the Secretary of State against the determination, and pending the determination of the appeal the FHSA shall not remove his name from the obstetric list.

(17) An appeal to the Secretary of State under paragraph (16) shall be made in writing and shall include a statement of the grounds of appeal and on any such appeal the Secretary of State shall, if he allows the appeal, direct that the FHSA shall not remove the doctor’s name from the obstetric list.

(18) The FHSA shall comply with any direction given to it under this regulation.

(19) Where the Secretary of State holds an oral hearing of an appeal pursuant to paragraph (12) the appellant and the FHSA may be represented by counsel, solicitor or any other person.

Obtaining maternity medical services

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(1) Maternity medical services shall comprise—

(a) the provision of personal medical services to a woman during the ante-natal period;

(b) the provision of personal medical services to a woman during labour;

(c) the provision of personal medical services to a woman and to her baby, as specified in paragraph 3(b) of Part II of Schedule 5, during the post-natal period; and

(d) the provision of a full post-natal examination.

(2) A woman who, after a doctor has diagnosed that she is pregnant, requires the provision of maternity medical services may arrange for the provision of any or all of the services mentioned in paragraph (1) with—

(a) any doctor in the obstetric list;

(b) the doctor on whose list she is included; or

(3) A doctor with whom a woman has made an arrangement under paragraph (2) for the provision of any or all of the services mentioned in paragraph (1) shall provide such services as are specified in Part II of Schedule 5.

(4) The provisions of regulation 20 shall apply to the making of an arrangement by a woman with a doctor for the provision of any or all of the services mentioned in paragraph (1) as they apply to the making of an application for inclusion in a doctor’s list.

(5) An arrangement between a woman and a doctor for the provision of any or all of the services mentioned in paragraph (1) may be terminated—

(a) by the woman—

(i) so informing the FHSA in writing,

(ii) so informing the doctor in writing who shall within 7 days notify the FHSA in writing, or

(iii) making a new arrangement with another doctor who shall within 7 days notify the FHSA in writing of the new arrangement;

(b) by the doctor making an application under paragraph 11 of the terms of service; or

(i) she ceases to be resident in the doctor’s practice area, or

(ii) the doctor’s responsibility for her is terminated under paragraph 10 of the terms of service,

whichever first occurs.

(6) Where the FHSA receives notification in accordance with paragraph (5)(a)(i) or (iii), it shall within 7 days notify the original doctor in writing that the woman’s arrangement with him has been terminated.

(7) In this regulation and in Schedule 5 “ante-natal period” means the duration of a woman’s pregnancy until the onset of labour and “post-natal period” means the period of 14 days following the conclusion of a pregnancy.

Minor surgery list

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(1) The FHSA shall maintain a list (in these Regulations referred to as “the minor surgery list”) of the names of those doctors who have satisfied the FHSA or, on appeal, the Secretary of State in accordance with the following provisions of this regulation that they have such medical experience, training and facilities as are necessary to enable them properly to provide all of the procedures listed in Schedule 6.

(2) A doctor may apply in accordance with paragraph (3), to a FHSA for the inclusion of his name in the minor surgery list maintained by that FHSA.

(3) An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part IX of Schedule 3.

(4) Unless the doctor otherwise agrees, the FHSA shall determine an application made in accordance with paragraph (3) within 2 months of receiving it.

(5) The FHSA may, if it thinks fit, hold an oral hearing of any application and shall not refuse an application without giving the doctor an opportunity of an oral hearing.

(6) Where the FHSA decides to hold an oral hearing, it shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the doctor.

(7) When determining an application the FHSA shall have regard—

(a) for the purpose of assessing the doctor’s medical experience and training, to any—

(i) post-graduate qualification held by him,

(ii) any training undertaken by him and any medical experience gained by him, during the period of five years immediately preceding the date of the application,

which is relevant to the provision of minor surgery services;

(b) for the purpose of assessing the doctor’s facilities, to the premises and the equipment to be used by the doctor in the provision of minor surgery services,

and shall seek and take into account any medical advice it considers necessary to enable it to determine the application.

(8) The FHSA shall determine an application by either—

(a) granting the application; or

(b) refusing the application.

(9) The FHSA shall inform the doctor in writing of its determination and shall—

(a) where it refuses the application, give notice in writing to him of the reasons for the determination and of his right of appeal under paragraph (10); or

(b) where it grants the application, forthwith include the doctor’s name in its minor surgery list.

(10) If an application is refused the doctor may appeal in writing to the Secretary of State within 30 days of receiving notice in writing of the FHSA’s determination.

(11) On any appeal pursuant to paragraph (10) or (15) the Secretary of State—

(a) may, if he thinks fit, hold an oral hearing of the appeal and, in such a case shall—

(i) appoint one or more persons to hear the appeal who shall report to him on the appeal, and

(ii) not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the FHSA;

(b) in determining the appeal, shall either confirm or reverse the determination of the FHSA and shall communicate his decision, together with the reasons for it, to the appellant and to the FHSA; and

(c) where he reverses the determination of the FHSA, shall direct that the FHSA include the doctor’s name in its minor surgery list.

(12) Subject to paragraphs (13) to (18), a doctor’s name may be removed from the minor surgery list only if—

(a) it has been removed from the medical list of any FHSA pursuant to regulation 6(3) or regulation 7; or

(b) the FHSA has determined that the doctor has not provided minor surgery services at any time during the past 5 years.

(13) Before making any determination under sub-paragraph (b) of paragraph (12) the FHSA shall—

(a) give the doctor 30 days' written notice of its intention to do so; and

(b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the FHSA.

(14) Where the FHSA makes a determination under sub-paragraph (b) of paragraph (12), it shall send to the doctor a notice in writing which shall include a statement—

(a) to the effect that, subject to any appeal under paragraph (15), the doctor’s name will, after 30 days from the date of the notice, be removed from the minor surgery list maintained by the FHSA;

(b) of the FHSA’s reasons for its determination; and

(15) A doctor who has received a notice in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Secretary of State against the determination, and pending the determination of the appeal, the FHSA shall not remove his name from the minor surgery list.

(16) An appeal under paragraph 15 to the Secretary of State shall be made in writing and shall include a statement of the grounds of appeal and on any such appeal the Secretary of State shall, if he allows the appeal, direct that the FHSA shall not remove the doctor’s name from the minor surgery list.

(17) The FHSA shall comply with any direction given to it under this regulation.

(18) Where the Secretary of State holds an oral hearing of an appeal pursuant to paragraph (11)(a), the appellant and the FHSA may be represented by counsel, solicitor or any other person.

Obtaining minor surgery services

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(1) A person may apply either in writing or in person to a doctor—

(a) who is—

(i) the doctor in whose list he is included (in this paragraph referred to as “his own doctor”),

(ii) a doctor with whom his own doctor is in partnership, or

(iii) a doctor with whom his own doctor is associated in a group practice; and

(b) whose name is included in the medical list and the minor surgery list of the FHSA,

for the provision of a procedure specified in Schedule 6 to these Regulations and the provisions of regulation 20(2) shall apply to that application as if the reference in regulation 20(2) to an application to a doctor for inclusion in his list were a reference to an application to a doctor for minor surgery services.

(2) A doctor whose name is included in the medical list may, in respect of any person on his list or on the list of a doctor with whom he is in partnership or with whom he is associated in group practice, undertake to provide minor surgery services, provided that his name is included in the minor surgery list.

(3) A doctor who has undertaken, pursuant to paragraph (2), to provide minor surgery services in respect of any patient shall offer to provide any of the procedures described in Schedule 6 which it is, in his opinion, appropriate for him to provide in the case of that patient.

(4) Where a doctor provides minor surgery services in respect of a patient who is not included on his list, he shall inform in writing the doctor on whose list the patient is included of the outcome of the procedure.

(5) Nothing in this regulation shall prevent any doctor personally performing, in the course of providing general medical services (otherwise than by way of minor surgery services) to a patient, a procedure described in Schedule 6.

PART VI — PAYMENTS TO DOCTORS

Payments

34

(1) In respect of each financial year the FHSA shall make payments to doctors with whom arrangements for the provision of general medical services exist in its locality, in accordance with such rates and subject to such conditions as the Secretary of State may determine and publish in a Statement, after consultation with such organisations as he may recognise as representing doctors with whom arrangements for the provision of general medical services exist.

(2) The determination under paragraph (1) shall make provision for the following matters—

(a) basic practice allowance, and additional allowances for designated areas, seniority and employment of assistants;

(b) standard capitation fees and capitation fees for elderly patients;

(d) fees and allowances for the supply of drugs and appliances and for rural practice;

(e) allowances for training doctors and for study leave;

(f) allowances for initial practice or inducement to practise;

(g) allowances for practice expenses and, in particular, allowances for practice staff including any who are spouses or other relatives and who provide qualifying services in accordance with the determination;

(h) allowances for improvement of premises;

(i) group practice loans;

(j) fees for contraceptive services;

(k) payments in relation to the making of arrangements for, and payments for, the temporary provision of general medical services;

(l) capitation fees in respect of patients who participate in a consultation pursuant to paragraph 14 of the terms of service;

(m) capitation fees in respect of patients to whom child health surveillance services are provided;

(n) capitation fees in respect of patients living in deprived areas;

(o) fees for minor surgery sessions undertaken;

(p) fees in respect of the provision of health promotion clinics approved by the FHSA;

(q) target payments in respect of immunisations provided;

(r) target payments in respect of cervical cytology;

(s) allowances for the employment of locums by a doctor during maternity leave, sickness or study leave;

(t) allowances for undergoing approved post-graduate education;

(u) allowances for the employment of doctors by isolated single-handed doctors;

(v) allowances in respect of providing placements in the practice for undergraduate medical students;

(w) transitional payments in consequence of changes to doctors' terms of service.

(3) The determination under paragraph (1) may be amended from time to time by the Secretary of State after consultation with the organisations referred to in that paragraph and any amendments shall also be published in a Statement.

(4) Where a doctor is in the medical list of more than one FHSA, any payment due to the doctor may, where the Statement so provides, be made on behalf of all FHSAs concerned.

Claims and overpayments

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(1) Any claim for fees, allowances or other remuneration by doctors shall be made in accordance with the provisions of the Statement under regulation 34.

(2) Where the FHSA considers that a payment has been made in circumstances when it was not due, the FHSA, except to the extent that the Secretary of State on the application of the FHSA directs otherwise, shall draw the overpayment to the attention of the doctor and—

(a) where the overpayment is admitted by him; or

(b) where the overpayment is not so admitted but, the matter having been referred under regulation 7(1) of the National Health Service (Service Committees and Tribunal) Regulations 1992[^f00019] for investigation, the FHSA, or the Secretary of State on appeal under regulation 10(1)(c) of those Regulations, decides that there has been an overpayment,

the amount overpaid shall be recoverable either by deduction from the doctor’s remuneration or in some other manner.

(3) Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service.

PART VII — MISCELLANEOUS

Determination of question whether a substance is a drug, and recovery of cost

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(1) Any question whether a substance ordered by a doctor for provision by a chemist was a drug the provision of which formed part of pharmaceutical services provided under the Act shall be determined under the provisions of this regulation.

(2) Where it appears to the FHSA that a question arises under sub-paragraph (1), the FHSA shall—

(a) notify the doctor who supplied or ordered the substance of the nature of the question arising; and

(b) invite him to state in writing, within 30 days from the date on which the notice was sent to him, whether he wishes the question to be referred to the Local Medical Committee for its opinion.

(3) The FHSA—

(a) shall, where the doctor states that he wishes the question to be referred to the Local Medical Committee for its opinion, refer the question accordingly;

(b) in any other case, may refer the question to the Local Medical Committee for its opinion; and

(c) may, in any event, seek such medical or pharmaceutical advice as it thinks fit, otherwise than from the Local Medical Committee.

(4) Where the question is referred to the Local Medical Committee under the provisions of paragraph (3), that Committee shall—

(a) furnish the doctor concerned with a statement indicating the nature of the question referred to it by the FHSA; and

(b) give the doctor concerned a reasonable opportunity to—

(i) submit to it any statement in writing, and

(ii) appear before it and be heard by it, in connection with the question so referred.

(5) The Local Medical Committee shall—

(a) in forming its opinion under this regulation, have regard to any information or evidence provided by the FHSA in connection with the question referred to it; and

(b) inform the doctor and the FHSA, in writing, of its opinion, its findings of fact and its reasons for its opinion.

(6) The FHSA shall—

(a) send notice of the question, in writing, to—

(i) the doctor who ordered the substance,

(ii) the person to whom the order was given, and

(iii) any other person who, in the opinion of the FHSA, has an interest in the determination of the question; and

(b) invite any such person to submit to the FHSA his comments in writing on that question within 30 days or within such further period as the FHSA may for reasonable cause allow.

(7) The FHSA shall, in determining the question, have regard to any opinion obtained by it under any of the provisions of paragraphs (3) to (5), and shall—

(a) send notice of its decision in writing to—

(i) the doctor concerned,

(ii) the Local Medical Committee, and

(iii) any person who submitted comments under paragraph (6); and

(b) where it determines that the substance in question is not a drug the provision of which formed part of pharmaceutical services, inform the doctor of his right of appeal under paragraph (8).

(8) Where the FHSA has determined that the substance in question is not a drug the provision of which formed part of pharmaceutical services, the doctor may appeal to the Secretary of State by giving notice of appeal, within 30 days from the date on which the notice of the decision was sent to him or within such longer period as the Secretary of State may, for reasonable cause, allow.

(9) Any notice of appeal given under this regulation shall be given in writing and shall contain a concise statement of the grounds of appeal.

(10) The Secretary of State shall send a copy of the notice of appeal to the FHSA whose determination is appealed against and to any person who submitted comments to the FHSA under paragraph (6).

(11) Any person to whom a copy of the notice of appeal is sent pursuant to paragraph (10) may, within 30 days from the date on which the notice was sent to him, make representations in writing to the Secretary of State on the appeal.

(12) The Secretary of State shall require an oral hearing of the appeal before he determines it.

(13) An oral hearing shall take place at such time and place as the Secretary of State may direct, and notice of the hearing shall be sent, not less than 14 days before the date fixed for the hearing, to the appellant and to any person who received a copy of the notice of appeal under paragraph (10).

(14) The appellant and any person mentioned in paragraph (10) may attend and be heard in person or by Counsel, solicitor or other representative and the FHSA may be represented at the hearing by any duly authorised officer or member, or by Counsel or solicitor.

(15) The Secretary of State shall determine the procedure at the oral hearing as he sees fit and, on determining the appeal, shall either—

(a) allow the appeal; or

(b) confirm the decision of the FHSA.

(16) The Secretary of State shall, as soon as practicable, send to the appellant and to any person mentioned in paragraph (10) notice in writing of his decision on the appeal and shall include in the notice a statement of his reasons for the decision and of his findings of fact.

(17) Where an FHSA or, on appeal, the Secretary of State has determined that a substance was not a drug the provision of which formed part of pharmaceutical services provided under the Act, the FHSA shall recover from the doctor who supplied or ordered the substance, by deduction from his remuneration or otherwise, an amount calculated in accordance with paragraph (19).

(18) Any amount determined as being recoverable under this regulation shall be a debt owing by the doctor to the FHSA by which it is recoverable.

(19) For the purposes of paragraph (18), the amount to be recovered in respect of the supply of any substance shall be the cost of that substance to the FHSA, including the dispensing fee payable in respect of the supply of the preparation, and where the substance was an ingredient in a preparation of which other ingredients were drugs, the amount to be recovered shall be the cost of that substance to the FHSA together with one-half of the amount of the dispensing fee payable in respect of the supply of the preparation.

Publication of particulars

37

(1) The FHSA shall publish the local directory and the medical list and shall make available for inspection at its office copies of—

(a) the medical list;

(b) the terms of service;

(d) the local directory; and

(e) a compendium of practice leaflets provided to it by doctors whose names are included in its medical list,

and shall keep them up to date.

(2) The FHSA shall make the documents mentioned in paragraph (1) available for inspection at such other places in its locality as appear to it convenient for informing all persons interested or may publish at such places a notice of the places and times at which copies of such documents may be seen.

(3) The FHSA shall—

(a) send a copy of the medical list to the Secretary of State, the Medical Practices Committee, the Local Medical Committee, and the Local Pharmaceutical Committee and to any person providing general medical or pharmaceutical services in its locality; and

(b) at intervals of not more than three months notify them of any alterations.

(4) Notwithstanding paragraph (3), if the FHSA considers that only parts of the medical list, or that only some of the alterations, are likely to concern any such persons or bodies, it may send to those persons or bodies a copy of only those parts or alterations.

Appointment of medical adviser

38

An FHSA shall appoint a doctor to assist it in the exercise of its functions pursuant to paragraph 49 of the terms of service for doctors (inquiries about prescriptions and referrals).

Guidance to doctors

39

(1) An FHSA may issue guidance to doctors whose names are included in its medical list to assist them in assessing in accordance with paragraph 28 of the terms of service, the qualifications, experience and competence of any employee, or prospective employee.

(2) Any guidance issued for the purposes of paragraph (1) in connection with the employment of members of any profession or other occupational group shall have regard to any statement as to minimum professional standards of conduct published by any body responsible for the regulation of that profession or occupational group.

SCHEDULE 1 — PROVISIONS CONFERRING POWERS EXERCISED IN MAKING THESE REGULATIONS (1)(2)

(1)	(2)
Provision	Relevant amendments
National Health Service Act 1977[^f00020]—
section 7(2)(a)	Health Services Act 1980[^f00021] (“the 1980 Act”), Schedule 1, paragraphs 35 and 90;
section 15(1)	Health and Social Security Act 1984[^f00022] (“the xmlns="http://www.tso.co.uk/assets/namespace/legislation" 1984 Act”), section 5(2) and Schedule 8;
	National Health Service and Community Care Act 1990[^f00023] (“the 1990 Act”), section 12;
section 16(1)(b)	The 1980 Act, Schedule 1, Part I, paragraph 36(a);
section 29[^f00024]	The 1980 Act, section 7 and Schedule 1, paragraphs 42 and 93; Health and Social Services and Social Security Adjudications Act 1983[^f00025], Schedule 6, paragraph 2; Family Practitioner Committees (Consequential Modifications) Order 1985[^f00026] (“the 1985 Order”), article 7(3);
section 30(1)	1980 Act, Schedule 1, paragraph 43(a) and Schedule 7; European Communities (Medical, Dental and Nursing Professions) (Linguistic Knowledge) Order 1981[^f00027], article 3(1)(a); 1985 Order, article 7(4);
section 31(1)	1985 Order, article 7(5);
section 33(2A), (4)	1985 Order, article 7(7); 1990 Act, section 23;
section 34	1985 Order, article 7(8); 1990 Act, section 23;
section 45(1)	1984 Act, Schedule 3, paragraph 7(a);
section 50
section 126(4)	1990 Act, section 65(2);
section 127(a)
section 128(1) (definitions of “prescribed” and “regulations”)	1990 Act, section 26(2);
Schedule 5, paragraph 12(b) and (c)
Schedule 10, paragraph 1(3)
Health and Medicines Act 1988 section 8(1)(a) and (5)

SCHEDULE 2 — TERMS OF SERVICE FOR DOCTORS

Interpretation

1

In this Schedule, unless the context otherwise requires—

“appliance” means an appliance which is included in a list for the time being approved by the Secretary of State for the purposes of section 41 of the Act[^f00028];

“assistant” includes a trainee general practitioner;

“chemical reagent” means a chemical reagent which is included in a list for the time being approved by the Secretary of State for the purposes of section 41 of the Act;

“deputy” means a person to whom a doctor has, under paragraph 19, delegated the treatment of his patient;

“deputising service” means any person or body carrying on a business which is concerned with the provision of a deputy or deputies for doctors for periods which do not normally exceed 48 hours;

“drugs” includes medicines;

“Drug Tariff” means the statement published under regulation 18 of the Pharmaceutical Regulations;

“post-natal period” means the period of 14 days following the conclusion of a pregnancy;

“prescription form” means a form provided by a health authority, an FHSA or, where the doctor is in the medical list of more than one FHSA, by the FHSA which is responsible for the supply of that form, and issued by a doctor to enable a person to obtain pharmaceutical services;

“Scheduled drug” means a drug or other substance specified in Schedule 10 or, except where the conditions in paragraph 44(2) are satisfied, in Schedule 11;

2

Unless the context otherwise requires, any reference in a paragraph in this Schedule to a numbered sub-paragraph is a reference to the sub-paragraph bearing that number in that paragraph.

General

3

Where a decision whether any, and if so what, action is to be taken under these terms of service requires the exercise of professional judgment, a doctor shall not, in reaching that decision, be expected to exercise a higher degree of skill, knowledge and care than—

(a) in the case of a doctor providing child health surveillance services under regulation 28, maternity medical services under regulation 31 or minor surgery services under regulation 33, that which any general practitioner included in the child health surveillance list, the obstetric list or, as the case may be, the minor surgery list may reasonably be expected to exercise; and

(b) in any other case, that which general practitioners as a class may reasonably be expected to exercise.

A doctor’s patients

4

(1) Subject to sub-paragraph (2) and to paragraphs 9, 10 and 11, a doctor’s patients are—

(a) persons who are recorded by the FHSA as being on his list;

(b) persons whom he has accepted or agreed to accept on his list, whether or not notification of that acceptance has been received by the FHSA, and who have not been notified to him by the FHSA as having ceased to be on his list;

(d) persons who have been assigned to him under regulation 21;

(e) for the limited period specified in sub-paragraph (5), persons in respect of whom he has been notified that an application has been made for assignment to him in a case to which regulation 21(3)(b) applies;

(f) persons whom he has accepted as temporary residents;

(g) in respect of services under paragraph 8, persons to whom he has agreed to provide those services;

(h) persons to whom he may be requested to give treatment which is immediately required owing to an accident or other emergency at any place in his practice area, provided that—

(i) he is not, at time of the request, relieved of liability to give treatment under paragraph 5, and

(ii) he is not, at the time of the request, relieved, under paragraph 19(2), of his obligation to give treatment personally, and

(iii) he is available to provide such treatment,

and any persons by whom he is requested, and agrees, to give treatment which is immediately required owing to an accident or other emergency at any place in the locality of any FHSA in whose medical list he is included, provided there is no doctor who, at the time of the request, is under an obligation otherwise than under this head to give treatment to that person, or there is such a doctor but, after being requested to attend, he is unable to attend and give treatment immediately required;

(i) persons in relation to whom he is acting as deputy for another doctor under these terms of service;

(j) during the period of an appointment under regulation 25, persons whom he has been appointed to treat temporarily;

(k) in respect of child health surveillance services, contraceptive services, maternity medical services, or minor surgery services persons for whom he has undertaken to provide such services; and

(l) during the hours arranged with the FHSA, any person whose own doctor has been relieved of responsibility during those hours under paragraph 19 and for whom he has accepted responsibility under that paragraph.

(2) Except in a case to which head (h), (i) or (j) of sub-paragraph (1) applies, no person shall be a patient for the purposes of that sub-paragraph if the doctor has been notified by the FHSA that he is no longer responsible for the treatment of that person.

(3) Where a person applies to a doctor for treatment and claims to be on that doctor’s list, but fails to produce his medical card on request and the doctor has reasonable doubts about that person’s claim, the doctor shall give any necessary treatment and shall be entitled to demand and accept a fee accordingly under paragraph 38(f), subject to the provision for repayment contained in paragraph 39.

(4) Where a doctor refuses to accept for inclusion on his list a person who lives in his practice area and who is not on the list of another doctor practising in that area, or refuses to accept as a temporary resident a person to whom regulation 26 applies, he shall on request give that person any immediately necessary treatment for one period not exceeding 14 days from the date when that person was refused acceptance or until that person has been accepted by or assigned to another doctor, whichever period is the shorter.

(5) Where the FSHA has notified a doctor that it is applying for the Secretary of State’s consent under regulation 21(3)(b), the doctor shall give the person proposed for assignment any immediately necessary treatment until the FHSA has notified him that—

(a) the Secretary of State has determined whether or not the person is to be assigned to that doctor; and

(b) either the person has been accepted by, or assigned to, another doctor or another doctor has been notified that an application has been made, in a case to which regulation 21(3)(b) applies, to assign that person to him.

5

A doctor who is elderly or infirm or who has been exempted by the FHSA under regulation 21(11) from the liability to have persons assigned to him, may be relieved by the FHSA of any liability to give treatment which is immediately required owing to an accident or other emergency between 7pm on weekdays and 8am on the following morning and between 1pm on Saturday and 8am on the following Monday to persons who are neither—

(a) on his list; nor

(b) temporary residents for whom he is responsible; nor

Acceptance of patients

6

(1) Subject to sub-paragraph (2), a doctor may agree to accept a person on his list if the person is eligible to be accepted by him.

(2) Where a doctor is responsible for treating the patients of another doctor whose name has been removed from the medical list, he may not consent to the transfer of any of those patients under regulation 22 to his own list or to that of his partner.

(3) Where a doctor has agreed to accept a person on his list, he shall, within 14 days of receiving that person’s medical card or form of application, or as soon after the expiry of that period as is practicable—

(a) sign the medical card or, as the case may be, the form of application; and

(b) send it to the FHSA.

(4) Where, for the purposes of sub-paragraph (3), any person signs a medical card or form of application on behalf of a doctor he shall, in addition to his own signature, specify the name of the doctor on whose behalf he is signing.

7

A doctor may—

(a) undertake to provide contraceptive services to a woman who has applied to him in accordance with regulation 29;

(b) accept as a temporary resident a person who has applied to him in accordance with regulation 26(1);

(c) undertake to provide maternity medical services to a woman who has made an arrangement with him in accordance with regulation 31(2).

8

Notwithstanding that the person concerned is not on his list, a doctor may—

(a) take a cervical smear from a woman who would be eligible for acceptance by him as a temporary resident or for whom he has undertaken to provide maternity medical services or contraceptive services; and

(b) vaccinate or immunise a person who would be eligible for acceptance by him as a temporary resident.

Termination of responsibility for patients

9

(1) A doctor may have any person removed from his list and shall notify the FHSA in writing that he wishes to have a person removed from his list and, subject to sub-paragraph (2), the removal shall take effect—

(a) on the date on which the person is accepted by or assigned to another doctor; or

(b) on the eighth day after the FHSA receives the notice,

whichever is the sooner.

(2) Where, at the date when the removal would take effect under sub-paragraph (1), the doctor is treating the person at intervals of less than 7 days, the doctor shall inform the FHSA in writing of the fact and the removal shall take effect—

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

(b) on the date on which the person is accepted by or assigned to another doctor,

whichever is the sooner.

10

Where a doctor informs the FHSA in writing that he wishes to terminate his responsibility for a temporary resident, his responsibility for that person shall cease in accordance with paragraph 9, as if the temporary resident were a person on his list.

11

(1) A doctor with whom an arrangement has been made for the provision of any or all of the maternity medical services mentioned in regulation 31(1)(a) may agree with the woman concerned to terminate the arrangement, and in default of agreement the doctor may apply to the FHSA for permission to terminate the arrangement.

(2) On an application under paragraph (1), the FHSA, after considering any representations made by either party and after consulting the Local Medical Committee, may terminate the arrangement.

(3) Where a doctor ceases to provide any or all of the maternity medical services mentioned in regulation 31(1)(a), he shall inform any woman for whom he has arranged to provide such services that he is ceasing to provide them and that she may make a fresh arrangement to receive those services from another doctor.

Services to patients

12

(1) Subject to paragraphs 3, 13 and 44, a doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general medical practitioners.

(2) The services which a doctor is required by sub-paragraph (1) to render shall include the following:

(a) giving advice, where appropriate, to a patient in connection with the patient’s general health, and in particular about the significance of diet, exercise, the use of tobacco, the consumption of alcohol and the misuse of drugs or solvents;

(b) offering to patients consultations and, where appropriate, physical examinations for the purpose of identifying, or reducing the risk of, disease or injury;

(c) offering to patients, where appropriate, vaccination or immunisation against measles, mumps, rubella, pertussis, poliomyelitis, diphtheria and tetanus;

(d) arranging for the referral of patients, as appropriate, for the provision of any other services under the Act; and

(e) giving advice, as appropriate, to enable patients to avail themselves of services provided by a local social services authority.

(3) A doctor is not required by sub-paragraph (1) or (2)—

(a) to provide to any person child health surveillance services, contraceptive services, minor surgery services nor, except in an emergency, maternity medical services, unless he has previously undertaken to the FHSA to provide such services to that person; or

(b) where he is a restricted services principal, to provide any category of general medical services which he has not undertaken to provide.

Provision of services to patients

13

The services referred to in paragraph 12 shall be rendered by a doctor—

(a) at his practice premises;

(b) if the condition of the patient so requires—

(i) at the place where the patient was residing when he was accepted by the doctor pursuant to paragraph 6 or, as the case may be, when he was assigned to the doctor pursuant to regulation 21 or, in the case of a patient who was previously on the list of a doctor in a practice declared vacant, when the doctor succeeded to the vacancy,

(ii) at such other place as the doctor has informed the patient and the FHSA is the place where he has agreed to visit and treat the patient if the patient’s condition so requires, or

(iii) in any other case, at some other place in the doctor’s practice area; or

Newly registered patients

14

(1) Subject to sub-paragraphs (4) to (9), where a patient has been accepted on a doctor’s list under paragraph 6 or assigned to a doctor’s list under regulation 21, the doctor shall, in addition to and without prejudice to his other obligations in respect of that patient under these terms of service, within 28 days of the date of such acceptance or assignment invite the patient to participate in a consultation either at his practice premises or, if the condition of the patient so warrants, at such other place as the doctor is obliged under paragraph 13(b) to render personal medical services to that patient.

(2) Where a patient (or, in the case of a patient who is a child, his parent) agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i) illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer,

(ii) social factors (including employment, housing and family circumstances) which may affect his health,

(iii) factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol, and misuse of drugs or solvents) which may affect his health, and

(iv) the current state of his health;

(b) offer to undertake a physical examination of the patient, comprising—

(i) the measurement of his height, weight and blood pressure, and

(ii) the taking of a urine sample and its analysis to identify the presence of albumen and glucose;

(c) record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d) assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient;

(e) in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient (or, where the patient is a child, the parent) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(3) On each occasion where a doctor invites a patient or parent to participate in a consultation pursuant to sub-paragraph (1) he shall—

(a) make the invitation in writing or, if the invitation is initially made orally, confirm it in writing, by a letter either handed to the patient or his representative or sent to the patient or parent at the address recorded in his medical records as being his last home address;

(b) record in the patient’s medical records the date of each such invitation and whether or not it was accepted; and

(c) where, as a result of making the invitation, the doctor becomes aware that the patient is no longer residing at the address shown in his medical records, advise the FHSA accordingly.

(4) A doctor shall not be obliged to offer a consultation pursuant to sub-paragraph (1)—

(a) if he is a restricted services principal;

(b) in respect of a child under the age of 5 years;

(c) to any patient who, immediately before joining the list of the doctor, was a patient of a partner of the doctor and who, during the 12 months immediately preceding the date of his acceptance or assignment to the doctor’s list, had participated in a consultation pursuant to sub-paragraph (1); or

(d) to the extent allowed by the FHSA, to any patient within a class of patients in respect of which the FHSA or, on appeal, the Secretary of State has, pursuant to sub-paragraphs (5) to (8), deferred the doctor’s obligation under sub-paragraph (1).

(5) Where a doctor assumes responsibility for a list of patients on his succession to a practice declared vacant, or otherwise becomes responsible for a significant number of new patients within a short period, he may apply, in accordance with sub-paragraph (6), to the FHSA for the deferment of his obligation under sub-paragraph (1) for a period not exceeding 2 years from the date of the application.

(6) An application pursuant to sub-paragraph (5) shall be made in writing and shall be accompanied by a statement of the doctor’s proposals, by reference to particular classes of patient, with a view to securing that all eligible patients are invited to participate in a consultation pursuant to sub-paragraph (1) by the end of the period of the deferment.

(7) Within 2 months of receiving an application the FHSA shall determine it—

(a) by approving the application;

(b) by approving the application subject to conditions; or

(8) A doctor may appeal in writing to the Secretary of State against any refusal of an application, or against any condition subject to which an application is approved by the FHSA pursuant to sub-paragraph (7)(b), and on determining such an appeal the Secretary of State shall either confirm the FHSA’s decision or substitute his own determination for that of the FHSA.

(9) The Secretary of State shall notify the doctor in writing of his determination and shall include with the notice a statement of his reasons for it.

Patients not seen within 3 years

15

(1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligation under these terms of service, invite each patient on his list who appears to him—

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

(b) to have neither—

(i) within the preceding 3 years attended either a consultation with, or a clinic provided by, any doctor in the course of his provision of general medical services, nor

(ii) within the preceding 12 months been offered a consultation pursuant to this sub-paragraph by any doctor,

to participate in a consultation at his practice premises for the purpose of assessing whether he needs to render personal medical services to that patient.

(2) Sub-paragraph (1) shall not apply in the case of a doctor who is a restricted services principal.

(3) When inviting a patient to participate in a consultation pursuant to sub-paragraph (1) a doctor shall comply with the requirements of paragraph 14(3).

(4) Where a patient agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) where appropriate, seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i) illnesses, immunisations, allergies, hereditary diseases, medication and tests carried out for breast or cervical cancer,

(ii) social factors (including employment, housing and family circumstances) which may affect his health,

(iii) factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol, and misuse of drugs or solvents) which may affect his health, and

(iv) the current state of his health;

(b) offer to undertake a physical examination of the patient, comprising—

(i) the measurement of his blood pressure, and

(ii) the taking of a urine sample and its analysis to identify the presence of albumen and glucose, and

(iii) the measurement necessary to detect any changes in his body mass;

(c) record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d) assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient; and

(e) in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(5) In this paragraph “body mass” means the figure produced by dividing the number of kilograms in the patient’s weight by the square of the number of metres in his height.

Patients aged 75 years and over

16

(1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligations under these terms of service, in each period of 12 months beginning on 1st April in each year—

(a) invite each patient on his list who has attained the age of 75 years to participate in a consultation; and

(b) offer to make a domiciliary visit to each such patient,

for the purpose of assessing whether he needs to render personal medical services to that patient.

(2) Sub-paragraph (1) shall not apply in the case of any doctor who is a restricted services principal.

(3) Any consultation pursuant to sub-paragraph (1) may take place in the course of the domiciliary visit pursuant to that sub-paragraph.

(4) In the case of a patient who is accepted by a doctor pursuant to paragraph 6, or assigned to him pursuant to regulation 21 and who has attained the age of 75 years when he is so accepted or assigned, an invitation and an offer pursuant to sub-paragraph (1) shall be made within 12 months of the date of his acceptance or assignment.

(5) A doctor shall, when making an assessment following a consultation under sub-paragraph (1), record in the patient’s medical records the observations made of any matter which appears to him to be affecting the patient’s general health, including, where appropriate the patient's—

(a) sensory functions;

(b) mobility;

(d) physical condition including continence;

(e) social environment;

(f) use of medicines.

(6) A doctor shall keep with the patient’s medical records a report of any observations made in the course of a domiciliary visit made pursuant to sub-paragraph (1) which are relevant to the patient’s general health.

(7) When inviting a patient to participate in a consultation, or offering him a domiciliary visit, pursuant to sub-paragraph (1), a doctor shall comply with the requirements of paragraph 14(3) as if paragraph 14(3) referred to an offer as well as an invitation.

(8) Where a patient has participated in a consultation pursuant to sub-paragraph (1), the doctor shall offer to discuss with him the conclusions he has drawn, as a result of the consultation, as to the state of the patient’s health, unless to do so would, in the opinion of the doctor, be likely to cause serious harm to the physical or mental health of the patient.

17

(1) Unless prevented by an emergency, a doctor shall attend and treat any patient who attends for the purpose at any place, and during the hours, for the time being approved by the FHSA under paragraph 29, other than a patient who attends when an appointment system is in operation and who has not previously made, and is not then given, an appointment to see the doctor.

(2) In such a case the doctor may refuse to attend and treat the patient during that surgery period, provided that—

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