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The National Health Service (General Medical Services Contracts) Regulations 2015

Type Statutory-Instrument

Publication 2015-11-06

Last updated 2025-10-01

State In force

Department King's Printer of Acts of Parliament

Source legislation.gov.uk

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(a) supply in writing to a person specified in paragraph (3) (a “relevant person”), before the end of such reasonable period as that person may specify, such clinical information as a person specified in paragraph (3)(a) to (d) considers relevant about a patient to whom the contractor, or a person acting on behalf of the contractor, has issued or has refused to issue a medical certificate; and

(b) answer any inquiries by a relevant person about—

(i) a prescription form or medical certificate issued or created by, or on behalf of, the contractor, or

(ii) any statement which the contractor, or a person acting on behalf of the contractor, has made in a report.

(2) For the purpose of being satisfied that a patient consents, a contractor may rely on an assurance in writing from a relevant person that the consent of the patient has been obtained, unless the contractor has reason to believe that the patient does not consent.

(3) For the purposes of this regulation, “a relevant person” is—

(a) a medical officer;

(b) a nursing officer;

(d) a physiotherapist; or

(e) an officer of the Department for Work and Pensions who is acting on behalf of, and at the direction of, any person specified in sub-paragraphs (a) to (d).

(4) In this regulation—

“medical officer” means a medical practitioner who is—employed or engaged by the Department for Work and Pensions; orprovided by an organisation under a contract entered into with the Secretary of State for Work and Pensions;

“nursing officer” means a health care professional who is registered on the Nursing and Midwifery Register and who is—employed by the Department for Work and Pensions; orprovided by an organisation under a contract with the Secretary of State for Work and Pensions;

“occupational therapist” means a health care professional who is registered in the part of the register maintained by the Health Professions Council under article 5 of the Health Professions Order 2001 (establishment and maintenance of register) relating to occupational therapists and who is—employed or engaged by the Department for Work and Pensions; orprovided by an organisation under a contract entered into with the Secretary of State for Work and Pensions; and

“physiotherapist” means a health care professional who is registered in the part of the register maintained by the Health Professions Council under article 5 of the Health Professions Order 2001 (establishment and maintenance of register) relating to physiotherapists and who is—employed or engaged by the Department for Work and Pensions; orprovided by an organisation under a contract entered into with the Secretary of State for Work and Pensions.

Annual return and review

77

(1) The contractor must submit to NHS England an annual return relating to the contract which must require the same categories of information to be provided by all persons who hold contracts with NHS England and make available to NHS England a digital practice area map.

(2) NHS England may request a return relating to the contract at any time during each financial year in relation to such period (not including any period covered by a previous annual return) as may be specified in the request.

(3) The contractor must submit the completed return and make available the digital practice area map to NHS England —

(a) by a date which has been agreed as reasonable between the contractor and NHS England; or

(b) in the absence of such agreement, before the end of the period of 28 days beginning with the date on which the request was made.

(4) Following receipt of the return referred to in paragraph (1), NHS England must arrange with the contractor an annual review of its performance in relation to the contract.

(5) The contractor or NHS England may, if desired, invite the Local Medical Committee (if any) for the area in which the contractor is providing services under the contract to participate in the annual review.

(6) NHS England must prepare a draft record of the review referred to in paragraph (4) for comment by the contractor and, having regard to such comments, must produce a final written record of the review.

(7) NHS England must send a copy of the final record of the review referred to in paragraph (6) to the contractor.

Practice leaflet

78

(1) The contractor must compile a document (a “practice leaflet”) which must include the information specified in Part 6 of Schedule 3.

(2) The contractor must review its practice leaflet at least once in every period of 12 months and make any amendments necessary to maintain its accuracy.

(3) The contractor must make available a copy of the leaflet, and any subsequent updates, to its patients and prospective patients.

PART 11 — Complaints

Complaints procedure

79

(1) The contractor must establish and operate a complaints procedure to deal with complaints made in relation to any matter that is reasonably connected with the provision of services under the contract.

(2) The complaints procedure must comply with the requirements of the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 .

Co-operation with investigations

80

(1) The contractor must co-operate with—

(a) the investigation of any complaint made in relation to a matter that is reasonably connected with the provision of services under the contract by—

(i) NHS England, or

(ii) the Health Service Commissioner; and

(b) the investigation of any complaint made by an NHS body or local authority which relates to a patient or former patient of the contractor.

(2) In paragraph (1)—

“NHS body” means—in relation to England, NHS England or an integrated care board; andin relation to England and Wales, Scotland and Northern Ireland, an NHS trust, an NHS foundation trust, a Local Health Board, a Health Board, a Health and Social Services Board or a Health and Social Services Trust;

“local authority” means—a local authority within the meaning of section 1 of the Local Authority Social Services Act 1970 (local authorities);the Council of the Isles of Scilly; ...a council constituted under section 2 of the Local Government etc. (Scotland) Act 1994 (constitution of councils); or the council of a county or county borough in Wales; and

“Health Service Commissioner” means the person appointed as Health Service Commissioner for England in accordance with section 1 of, and Schedule 1 to, the Health Service Commissioners Act 1993 (The Commissioner).

(3) For the purposes of paragraph (1), co-operation includes—

(a) answering any questions which are reasonably put to the contractor by NHS England;

(b) providing any information relating to the complaint which is reasonably required by NHS England; and

(c) attending any meeting held to consider the complaint (if held at a reasonably accessible place and at a reasonable hour and if due notice has been given) if the contractor's presence at the meeting is reasonably required by NHS England .

PART 12 — Dispute resolution

Local resolution of contract disputes

81

(1) The contractor and NHS England must make reasonable efforts to communicate and co-operate with each other with a view to resolving any dispute which arises out of or in connection with the contract before referring the dispute for determination in accordance with the NHS dispute resolution procedure (or, where applicable, before commencing court proceedings).

(2) Paragraph (1) does not apply to a dispute relating to the assignment of patients to a closed list which falls to be determined under the NHS dispute resolution procedure by virtue of paragraph 42(1) of Schedule 3 where it is not practicable for the parties to attempt local resolution before the expiry of the period of seven days specified in paragraph 42(4) of that Schedule.

(3) The contractor or NHS England may invite the Local Medical Committee (if any) for the area in which the contractor is providing services under the contract to participate in discussions which take place by virtue of paragraph (1).

Dispute resolution: non-NHS contracts

82

(1) Where a contract is not an NHS contract, any dispute arising out of or in connection with the contract, except matters dealt with under the complaints procedure under Part 11, may be referred for consideration and determination to the Secretary of State—

(a) if it relates to a period when the contractor was treated as a health service body, by the contractor or NHS England ; or

(b) in any other case, by the contractor or, if the contractor agrees in writing, by NHS England.

(2) Where a dispute is referred to the Secretary of State under paragraph (1)—

(a) the procedure to be followed is the NHS dispute resolution procedure; and

(b) the parties are to be bound by any determination made by the adjudicator.

NHS dispute resolution procedure

83

(1) The procedure specified in this regulation and in regulation 82 applies to a dispute arising out of, or in connection with, the contract which is referred to the Secretary of State in accordance with—

(a) section 9(6) of the Act (where the contract is an NHS contract); or

(b) regulation 82(1) (where the contract is not an NHS contract).

(2) The procedure referred to in paragraph (1) does not apply where the contractor refers a matter for determination in accordance with paragraph 42 of Schedule 3 and, in such a case, the procedure specified in that paragraph applies instead.

(3) Where a party wants to refer a dispute for determination under the procedure specified in this regulation, it must send to the Secretary of State a written request for dispute resolution which must include or be accompanied by—

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

(b) a copy of the contract; and

(4) Where a party wants to refer a dispute, it must send a request under paragraph (3) to the Secretary of State before the end of the period of three years beginning with the date on which the matter giving rise to the dispute occurred or should reasonably have come to the attention of that party.

(5) Where the dispute relates to a contract which is not an NHS contract, the Secretary of State may—

(a) determine the dispute; or

(b) if the Secretary of State considers it appropriate, appoint one or more persons to consider and determine the dispute.

(6) Before reaching a decision about who should determine the dispute, either under paragraph (5) or section 9(6) of the Act, the Secretary of State must send a written request to the parties, before the end of the period of seven days beginning with the date on which the dispute was referred, inviting them to make any written representations that they would like to make about the matter under dispute before the end of a specified period.

(7) The Secretary of State must give to a party other than the one which referred the matter to dispute resolution a copy of any document by which the matter was referred to dispute resolution together with the notice under paragraph (6).

(8) The Secretary of State must—

(a) give a copy of any representations received from a party to the other party to the dispute; and

(b) request in writing each party to whom a copy of the representations is given to make, within a specified period, any written observations which that party would like to make regarding those representations.

(9) If the Secretary of State decides to appoint a person or persons (“the adjudicator”) to hear the dispute the Secretary of State must—

(a) inform the parties in writing of the name or names of the adjudicator whom the Secretary of State has appointed; and

(b) pass to the adjudicator any documents received from the parties under or by virtue of paragraph (3), (6) or (8).

(10) The Secretary of State must comply with the requirement in paragraph (9)—

(a) following receipt of any representations received from the parties; or

(b) if no such representations are received before the end of the period for making those representations specified in the request sent under paragraph (6) or (8), at the end of that period.

(11) The adjudicator may, for the purpose of assisting in the consideration of the subject matter of the dispute—

(a) invite representatives of the parties to appear before, and make oral representations to, the adjudicator either together or, with the agreement of the parties, separately;

(b) in advance of hearing any oral representations, provide the parties with a list of matters or questions that the adjudicator would like the parties to give special consideration to; or

(c) consult such other persons whose expertise the adjudicator considers is likely to assist in the consideration of the matter.

(12) Where the adjudicator consults another person under paragraph (11)(c), the adjudicator must—

(a) give notice in writing to the parties accordingly; and

(b) where the adjudicator considers that the interests of any party might be substantially affected by the result of the consultation, give to the parties such opportunity as the adjudicator considers reasonable in the circumstances to make observations on those results.

(13) In considering the matter, the adjudicator must have regard to—

(a) any written representations made in response to a request under paragraph (6), but only if they are made before the end of the specified period;

(b) any written observations made in response to a request under paragraph (8), but only if they are made before the end of the specified period;

(d) the results of any consultation under paragraph (11)(c); and

(e) any observations made in accordance with an opportunity given under paragraph (12).

(14) In this regulation, “specified period” means—

(a) such period as the Secretary of State specifies in the request being a period of not less than two or not more than four weeks beginning with the date on which the notice referred to is given; or

(b) such longer period as the Secretary of State may allow if the Secretary of State considers that there are good reasons for extending the period referred to in sub-paragraph (a) (even after that period has expired), and where the Secretary of State does so allow, a reference in this regulation to the specified period is to the period as so extended.

(15) The adjudicator may determine the procedure which is to apply to the dispute resolution in such manner as the adjudicator considers appropriate in order to ensure the just, expeditious, economical and final determination of the dispute subject to—

(a) the other provisions of this regulation;

(b) regulation 84; and

Determination of the dispute

84

(1) The adjudicator's determination and the reasons for it must be recorded in writing and the adjudicator must give notice in writing of that determination (including the record of the reasons) to the parties.

(2) Where a dispute in relation to a contract is referred for determination in accordance with regulation 82(1)—

(a) section 9(12) and (13) of the Act apply in the same manner as those provisions apply to a dispute referred for determination in accordance with section 9(6) and (7) of the Act; and

(b) section 90(5) of the Act applies to any dispute referred for determination in relation to a contract which is not an NHS contract as if it were referred for determination in accordance with section 9(6) of the Act.

Interpretation of this Part

85

(1) In this Part, “any dispute arising out of or in connection with the contract” includes any dispute arising out of or in connection with the termination of the contract.

(2) A term of the contract which makes provision in respect of the requirements of this Part is to survive even where the contract has terminated.

PART 13 — Functions of a Local Medical Committee

Functions of a Local Medical Committee

86

(1) The functions of a Local Medical Committee which are prescribed for the purposes of section 97(8) of the Act (Local Medical Committees) are—

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

(b) reporting the outcome of the consideration of any such complaint to NHS England where that consideration gives rise to concerns relating to the efficiency of the services provided under a contract;

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

(d) considering the report of any medical examination arranged in accordance with sub-paragraph (c) and reporting in writing to that medical practitioner, the contractor and NHS England about the capability of the medical practitioner to adequately provide services under the contract.

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

(a) a contractor;

(b) one of two or more persons practising in partnership which holds a contract; or

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

PART 14 — Miscellaneous

Clinical governance

87

(1) The contractor must have in place an effective system of clinical governance which includes appropriate standard operating procedures in relation to the management and use of controlled drugs.

(2) The contractor must nominate a person who is to have responsibility for ensuring the effective operation of the system of clinical governance.

(3) The person nominated under paragraph (2) must be a person who performs or manages the performance of services under the contract.

(4) In this regulation—

(a) “controlled drugs” has the meaning given in section 2 of the Misuse of Drugs Act 1971 (which relates to controlled drugs and their classification for the purposes of that Act); and

(b) “system of clinical governance” means a framework through which the contractor endeavours continuously to improve the quality of its services and to safeguard high standards of care by creating an environment in which clinical excellence can flourish.

Friends and Family Test

88

(1) A contractor must give all patients who use the contractor's practice the opportunity to provide feedback about the service received from the practice through the Friends and Family Test .

(2) The contractor must—

(a) report the results of completed Friends and Family Tests to NHS England; and

(b) publish the results of such completed Tests .

(3) In this regulation, “Friends and Family Test” means the arrangements that a contractor is required by NHS England to implement to enable its patients to provide anonymous feedback about the patient experience at the contractor's practice.

Co-operation with the Board

89

The contractor must co-operate with NHS England in the discharge of any of NHS England’s obligations, or the obligations of NHS England’s accountable officers, under the Controlled Drugs (Supervision and Management of Use) Regulations 2013 .

Co-operation with the Secretary of State and NHS England

90

The contractor must co-operate with—

(a) the Secretary of State in the discharge of the Secretary of State's duty under section 1F of the Act (duty as to education and training); or

(b) NHS England where NHS England is discharging the Secretary of State's duty under section 1F of the Act by virtue of its functions under section 97(1) of the Care Act 2014 (planning education and training for health care workers etc.).

Insurance

91

(1) The contractor must at all times have in force in relation to it an indemnity arrangement which provides appropriate cover.

(2) The contractor may not sub-contract its obligations to provide clinical services under the contract unless it is satisfied that the sub-contractor has in force in relation to it an indemnity arrangement which provides appropriate cover.

(3) In this regulation—

(a) “appropriate cover” means cover against liabilities that may be incurred by the contractor in the performance of clinical services under the contract, which is appropriate, having regard to the nature and extent of the risks in the performance of such services;

(b) “indemnity arrangement” means a contract of insurance or other arrangement made for the purpose of indemnifying the contractor; and

(c) a contractor is to be regarded as holding insurance if that insurance is held by a person employed or engaged by the contractor in connection with clinical services which that person provides under the contract or, as the case may be, sub-contract.

Public liability insurance

92

The contractor must at all times hold adequate public liability insurance in relation to liabilities to third parties arising under or in connection with the contract which are not covered by the indemnity arrangement referred to in regulation 91.

Gifts

93

(1) The contractor must keep a register of gifts which—

(a) are given to any of the persons specified in paragraph (2) by or on behalf of—

(i) a patient,

(ii) a relative of a patient, or

(iii) any person who provided or would like to provide services to the contractor or its patients in connection with the contract; and

(b) have, in the contractor's reasonable opinion, an individual value of more than £100.00.

(2) The persons specified in this paragraph are—

(a) the contractor;

(b) where the contract is with two or more persons practising in partnership, any partner in the partnership;

(i) any person both legally and beneficially owning a share in the company, or

(ii) a director or secretary of the company;

(d) any person employed by the contractor for the purposes of the contract;

(e) any general medical practitioner engaged by the contractor for the purposes of the contract;

(f) any spouse or civil partner of a contractor (where the contractor is an individual medical practitioner) or of a person specified in sub-paragraphs (b) to (e); or

(g) any person whose relationship with the contractor (where the contractor is an individual medical practitioner), or with a person specified in sub-paragraphs (b) to (e), has the characteristics of the relationship between spouses.

(3) Paragraph (1) does not apply where—

(a) there are reasonable grounds for believing that the gift is unconnected with services provided or to be provided by the contractor;

(b) the contractor is not aware of the gift; or

(4) The contractor must take reasonable steps to ensure that it is informed of any gifts which fall within paragraph (1) and which are given to the persons specified in paragraph (2)(b) to (g).

(5) The register referred to in sub-paragraph (1) must include the following information—

(a) the name of the donor;

(b) in a case where the donor is a patient, the patient's National Health Service number or, if the number is not known, the patient's address;

(d) the nature of the gift;

(e) the estimated value of the gift; and

(f) the name of the person or persons who received the gift.

(6) The contractor must make the register available to NHS England on request.

Compliance with legislation and guidance

94

The contractor must—

(a) comply with all relevant legislation; and

(b) have regard to all relevant guidance issued by NHS England, the Secretary of State or local authorities in respect of the exercise of their functions under the Act.

Third party rights

95

The contract does not create any right enforceable by any person who is not a party to it.

PART 15 — General transitional provision and saving, consequential amendments and revocations

General transitional provision and saving

96

(1) This regulation applies to—

(a) the exercise by NHS England of any of its functions under the 2004 Regulations on or before the commencement date;

(b) any rights or liabilities of NHS England in respect of the exercise of any of its functions under the 2004 Regulations; and

(c) any rights or liabilities of a Primary Care Trust transferred to NHS England as a consequence of a property transfer scheme made under section 300 of the Health and Social Care Act 2012 (transfer schemes).

(2) Subject to paragraph (4), any act or omission concerning a contract to which the 2004 Regulations applied immediately before the commencement date in respect of any of the matters specified in paragraph (1), is to be treated as an act or omission concerning a contract to which these Regulations apply.

(3) Subject to paragraph (4), anything which, on or before the commencement date, is done or is in the process of being done under the 2004 Regulations concerning a contract to which the 2004 Regulations applied immediately before that date in respect of any of the matters specified in paragraph (1), is to be treated as if done or in the process of being done under these Regulations.

(4) Notwithstanding paragraphs (2) and (3) and the revocations provided for in Schedule 5, where the 2004 Regulations contain a provision for which there is no equivalent provision in these Regulations (“the relevant provision”), the 2004 Regulations, as they were in force immediately before the commencement date, are to continue to apply to the extent necessary for the purposes of—

(a) preserving any rights conferred or liabilities accrued by or under the relevant provision; or

(b) the assessment or determination of any rights or liabilities arising under or in accordance with the relevant provision.

(5) In this regulation—

(a) “the commencement date” means the date on which these Regulations come into force;

(b) “contract” includes any contract to which the 2004 Regulations applied immediately before the commencement date under which medical services were provided before 1st January 2005 (whether or not such services continued to be provided after that date); and

(c) references to the exercise by NHS England of any of its functions include the exercise by NHS England of any functions of a Primary Care Trust under Part 4 of the Act.

Consequential amendments

97

Schedule 4 makes provision in respect of the amendments to secondary legislation which are consequential upon the coming into force of these Regulations.

Revocations

98

Schedule 5 makes provision in respect of the revocation of the enactments specified in column 1 of the Table in that Schedule to the extent specified in column 2 of that Table.

SCHEDULE 1 — Additional services

Additional services: general

1

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Cervical screening

2

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Contraceptive services

3

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

Vaccines and immunisations

4

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

Childhood vaccines and immunisations

5

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

Child health surveillance

6

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

Maternity medical services

7

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Minor surgery

8

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

SCHEDULE 2 — List of prescribed medical certificates

1

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

2

To establish pregnancy for the purpose of obtaining welfare foods

3

To secure registration of still-birth

4

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

5

To establish unfitness for jury service

6

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

7

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

8

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

9

To support a claim by or on behalf of a severely mentally impaired person for exemption from liability to pay the Council Tax or eligibility for a discount in respect of the amount of Council Tax payable

SCHEDULE 3 — Other contractual terms

PART 1 — Provision of services

Premises

1

(1) The contractor must ensure that the premises used for the provision of services under the contract are—

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

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

(2) The requirement in sub-paragraph (1) is subject to any plan included in the contract in accordance with regulation 20(5) which sets out steps to be taken by the contractor to bring the premises up to the required standard.

Telephone services

2

(1) The contractor must not be a party to a contract or other arrangement under which the number for telephone services (“relevant telephone services”) to be used by—

(a) patients to contact the contractor's practice for a purpose related to the contract; or

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

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

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

(3) The contractor must ensure that any new contract or other arrangement relating to relevant telephone services is procured under the Advanced Telephony Better Purchasing Framework.

(4) Where NHS England requires, the contractor must make available to NHS England, within such reasonable time frame as specified by NHS England, such information as specified by NHS England that is available to the contractor in relation to the handling of calls under relevant telephone services.

Cost of relevant calls

3

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

(2) Where it has not been possible for the contractor to take reasonable steps to ensure that persons will not pay more to make relevant calls to the contractor's practice than they would to make equivalent calls to a geographical number, the contractor must consider introducing a system under which, if a caller asks to be called back, the contractor will do so at the contractor's own expense.

(3) In this paragraph—

“geographical number” means a number which has a geographical area code as its prefix; and

“relevant calls” means—calls made by patients to the contractor's practice for any reason related to services provided under the contract; andcalls made by persons, other than patients, to the contractor's practice in relation to services provided as part of the health service.

Attendance at practice premises

4

(1) The contractor must take steps to ensure that all of the following means of contacting the contractor are available for patients throughout core hours—

(a) by attending the contractor’s practice premises;

(b) by telephone; and

(1A) The contractor must take steps to ensure that a patient who contacts the contractor through—

(a) any of the means listed in sub-paragraph (1)(a) to (c); or

(b) a relevant electronic communication method within the meaning given in regulation 71ZE(3),

is provided with an appropriate response in accordance with the following sub-paragraphs.

(2) The appropriate response is that the contractor must—

(a) invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances ...;

(b) provide appropriate advice or care to the patient by another method;

(c) invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves; or

(d) communicate with the patient—

(i) to request further information; or

(ii) as to when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.

(3) The appropriate response must be provided—

(a) if the contact ... is made outside core hours, during the following core hours;

(b) in any other case, during the day on which the core hours fall.

(4) The appropriate response must take into account—

(a) the needs of the patient , including the need to avoid jeopardising the patient’s health; ...

(b) where appropriate, the preferences of the patient ; and

(c) any benefits to the patient of providing for continuity of the health care professional involved in their care and treatment.

Attendance outside practice premises

5

(1) Where the medical condition of a patient is such that, in the reasonable opinion of the contractor—

(a) attendance on the patient is required; and

(b) it would be inappropriate for the patient to attend the contractor's practice premises,

the contractor must provide services to the patient at whichever of the places described in sub-paragraph (2) is, in the contractor's judgement, the most appropriate.

(2) The places described in this sub-paragraph are—

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

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

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

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

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

Newly registered patients

6

(1) Where a patient has been—

(a) accepted on a contractor's list of patients; or

(b) assigned to that list by NHS England,

the contractor must invite the patient to participate in a remote consultation or a consultation either at the contractor's practice premises or, if the patient's medical condition so warrants, at one of the places described in paragraph 5(2).

(2) An invitation under sub-paragraph (1) must be issued by the contractor before the end of the period of six months beginning with the date of the acceptance of the patient on, or assignment of the patient to, the contractor's list of patients.

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

(4) This paragraph and does not affect the contractor's other obligations under the contract in respect of the patient.

Newly registered patients – alcohol dependency screening

7

(1) Where a patient has been—

(a) accepted onto a contractor's list of patients; or

(b) assigned to that list by NHS England,

the contractor must, whether as part of the consultation which the contractor is required to offer the patient under paragraph 6(1) or otherwise, take action to identify any such patient over the age of 16 who is drinking alcohol at increasing or higher risk levels with a view to seeking to reduce the alcohol related risks to that patient.

(2) The contractor must comply with the requirement in sub-paragraph (1) by screening the patient using either of the two shortened versions of the World Health Organisations Alcohol Use Disorders Identification (“AUDIT”) questionnaire which are known as—

(a) FAST (which has four questions); or

(b) AUDIT-C (which has three questions).

(3) Where, under paragraph (2), the contractor identifies a patient as positive using one of the shortened versions of the AUDIT questionnaire specified in sub-paragraph (2), the remaining questions of the full ten question AUDIT questionnaire are to be used by the contractor to determine increasing risk, higher risk or likely dependent drinking.

(4) Where a patient is identified as drinking at increasing or higher risk levels, the contractor must—

(a) offer the patient appropriate advice and lifestyle counselling;

(b) respond to any other need identified in the patient which relates to the patient's levels of drinking, including by providing additional support or treatment required for people with mental health issues; and

(c) in any case where the patient is identified as a dependent drinker, offer the patient a referral to such specialist services as are considered clinically appropriate to meet the needs of the patient.

(5) Where a patient is identified as drinking at increasing or higher risk levels or as a dependent drinker, the contractor must ensure that the patient is—

(a) assessed for anxiety and depression;

(b) offered screening for anxiety and depression; and

(c) where anxiety and depression is diagnosed, provided with any treatment or support which may be required under the contract, including referral for specialist mental health treatment.

(6) The contractor must make relevant entries, including the results of the completed questionnaire referred to in sub-paragraph (2), in the patient's record that the contractor is required to keep under regulation 67.

Accountable GP

8

(1) A contractor must ensure that for each of its registered patients (including those patients under the age of 16) there is assigned an accountable general medical practitioner (“accountable GP”).

(2) The accountable GP must take lead responsibility for ensuring that any services which the contractor is required to provide under the contract are, to the extent that their provision is considered necessary to meet the needs of the patient, coordinated and delivered to the patient.

(3) The contractor must—

(a) inform the patient, as soon as is reasonably practicable and in such manner as is considered appropriate by the contractor's practice, of the assignment to the patient of an accountable GP and must state the name and contact details of the accountable GP and the role and responsibilities of the accountable GP in respect of the patient;

(b) inform the patient as soon as any circumstances arise in which the accountable GP is not able, for any significant period, to carry out the duties of an accountable GP in respect of the patient; and

(c) where the contractor's practice considers it to be necessary, assign a replacement accountable GP to the patient and inform the patient accordingly.

(4) The contractor must comply with the requirement in sub-paragraph (3)(a), in the case of any person who is accepted by the contractor as a registered patient on or after the date on which these Regulations come into force, within 21 days from the date on which that person is so accepted.

(5) The requirement in this paragraph does not apply to—

(a) any patient of the contractor who is aged 75 or over, or who attains the age of 75, on or after the date on which these Regulations come into force; or

(b) any other patient of the contractor if the contractor has been informed that the patient does not wish to have an accountable GP.

(6) Where, under sub-paragraph (3)(a), the contractor informs a patient of the assignment to the patient of an accountable GP, the patient may express a preference as to which general medical practitioner within the contractor's practice the patient would like to have as the patient's accountable GP and, where such a preference has been expressed, the contractor must make reasonable efforts to accommodate the request.

(7) Where, under sub-paragraph (5)(b), the contractor has been informed by, or in relation to, a patient that the patient does not wish to have an accountable GP, the contractor must record that fact in the patient's record that the contractor is required to keep under regulation 67.

(8) The contractor must ... include information about the requirement to assign an accountable GP to each of its new and existing registered patients—

(a) on the contractor's practice website or online practice profile; and

(b) in the contractor's practice leaflet.

(9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patients not seen within three years

9

(1) This paragraph applies where a registered patient who has attained the age of 16 years but has not attained the age of 75 years—

(a) requests a consultation with the contractor; and

(b) has not attended either a consultation with, or a clinic provided by, the contractor within the period of three years prior to the date of the request.

(2) The contractor must—

(a) provide the patient with a consultation; and

(b) during that consultation, make such inquiries and undertake such examinations of the patient as the contractor considers appropriate in all the circumstances.

(3) This paragraph does not affect the contractor's other obligations under the contract in respect of the patient.

Patients aged 75 and over

10

(1) Where a registered patient who requests a consultation—

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

(b) has not participated in a consultation within the 12 month period prior to the date of the request,

the contractor must provide such a consultation during which it must make such inquiries and undertake such examinations as it considers appropriate in all the circumstances.

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

(3) This paragraph does not affect the contractor's other obligations under the contract in respect of the patient.

Patients aged 75 and over: accountable GP

11

(1) A contractor must ensure that for each of its registered patients aged 75 and over there is assigned an accountable general medical practitioner (“accountable GP”).

(2) The accountable GP must—

(a) take lead responsibility for ensuring that any services which the contractor is required to provide under the contract are, to the extent that their provision is considered necessary to meet the needs of the patient, delivered to the patient;

(b) take all reasonable steps to recognise and appropriately respond to the physical and psychological needs of the patient in a timely manner;

(c) ensure that the patient receives a health check if, and within a reasonable period after, one has been requested; and

(d) work co-operatively with such other health and social care professionals who may become involved in the care and treatment of the patient to ensure the delivery of a multi-disciplinary care package designed to meet the needs of the patient.

(3) The contractor must—

(a) inform the patient, in such manner as is considered appropriate by the contractor's practice, of the assignment to the patient of an accountable GP;

(b) provide the patient with the name and contact details of the accountable GP and information regarding the role and responsibilities of the accountable GP in respect of the patient;

(c) inform the patient as soon as any circumstances arise in which the accountable GP is not able, for any significant period, to carry out the duties of an accountable GP in respect of the patient; and

(d) where the contractor's practice considers it to be necessary, assign a replacement accountable GP to the patient and inform the patient accordingly.

(4) The contractor must comply with the requirement in sub-paragraph (3)(a)—

(a) in the case of any person aged 75 or over who is accepted by the contractor as a registered patient on or after the date on which these Regulations come into force, before the end of the period of 21 days beginning with the date on which that person was so accepted; or

(b) in the case of any person who is included in the contractor's list of patients immediately before the date on which these Regulations come into force who attains the age of 75 or over on or after that date, before the end of the period of 21 days after the date on which that person attained that age.

(5) In this paragraph, “health check” means a consultation undertaken by the contactor which is of the type which a contractor is required to undertake at a patient's request under paragraph 10(1).

Clinical reports

12

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

(2) NHS England must send a report received in accordance with sub-paragraph (1) to the person with whom the patient is registered for the provision of essential services or their equivalent.

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

Storage of vaccines

13

The contractor must ensure that—

(a) all vaccines are stored in accordance with the manufacturer's instructions; and

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

Infection control

14

The contractor must ensure that it has appropriate arrangements in place for infection control and decontamination.

Duty of co-operation

15

(1) Where a contractor does not provide to its registered patients or to persons whom it has accepted as temporary residents—

(a) minor surgery;

(b) a particular enhanced service, except in relation to one provided under the Network Contract Directed Enhanced Service Scheme which is a scheme provided for by the Primary Medical Services (Directed Enhanced Services) Directions; or

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

(2) The requirements specified in this sub-paragraph are that the contractor must—

(a) co-operate, insofar as is reasonable, with any person responsible for the provision of that service or those services;

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

(i) take reasonable steps to ensure that any patient who contacts the contractor's practice ... during the out of hours period is provided with information about how to obtain services during that period,

(ii) ensure that the clinical details of all out of hours consultations received from the out of hours provider are reviewed by a clinician within the contractor's practice on the same working day as those details are received by the practice or, exceptionally, on the next working day,

(iii) ensure that any information requests received from the out of hours provider in respect of any out of hours consultations are responded to by a clinician within the contractor's practice on the same day as those requests are received by the contractor's practice, or on the next working day,

(iv) take all reasonable steps to comply with any systems which the out of hours provider has in place to ensure the rapid, secure and effective transmission of patient data in respect of out of hours consultations, and

(v) agree with the out of hours provider a system for the rapid, secure and effective transmission of information about registered patients who, due to chronic disease or terminal illness, are predicted as more likely to present themselves for treatment during the out of hours period.

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

Cessation of service provision: information requests

16

Where a contractor is to cease to be required to provide to its patients—

(a) minor surgery;

(b) a particular enhanced service; or

the contractor must comply with any reasonable request for information relating to the provision of that service, or those services, made by NHS England or by any person with whom NHS England intends to enter into a contract for the provision of such services.

PART 2 — Patients: general

List of patients

17

(1) NHS England must prepare and keep up to date a list of the patients who have been—

(a) accepted by the contractor for inclusion in the contractor’s list of patients under paragraph 18, 19, 19A, 32D or 32F and who have not been subsequently removed from that list under paragraphs 23 to 31; and

(b) assigned by NHS England to the Contractor’s list of patients under—

(i) paragraph 39(1)(a), or

(ii) paragraph 39(1)(b) (by virtue of a determination of the assessment panel under paragraph 41(8) which has not subsequently been overturned by a determination of the Secretary of State under paragraph 42 or by a court).

(2) The contractor must, upon receipt of a reasonable written request from NHS England—

(a) take appropriate steps as soon as is reasonably practicable, to correct and update patient data held on the practice’s computerised clinical systems, and where necessary register or deregister patients to ensure that the patient list is accurate; and

(b) provide information relating to its list of patients as soon as is reasonably practicable and, in any event, no later than 30 days from the date on which the request was received by the contractor, in order to assist NHS England in the exercise of its duties under paragraph (1), contacting patients where reasonably necessary to confirm that their patient data is correct.

Application for inclusion in a list of patients

18

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

(1A) NHS England may, following consultation with the Local Medical Committee (if any) for the area in which the contractor provides services under the contract, determine that in certain circumstances NHS England’s approval is required before a contractor accepts an application for inclusion in its list of patients in respect of a patient who resides outside the contractor’s practice area.

(1B) Where NHS England has made a determination in accordance with sub-paragraph (1A) it must set out the circumstances in which its approval is required in a notice to the contractor.

(1C) Where NHS England has made a determination in accordance with sub-paragraph (1A), a contractor may only accept an application for inclusion in its list of patients in respect of a person who resides outside the contractor’s practice area in the circumstances set out in a notice given under sub-paragraph (1B) with NHS England’s approval.

(2) If the contractor's list of patients is closed, the contractor may only accept an application for inclusion in that list made by or on behalf of a person who is an immediate family member of a registered patient whether or not that person is resident in the contractor's practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.

(3) Subject to sub-paragraph (4), the contractor may only accept an application for inclusion in that list if it is—

(a) an application on a form specified to the contractor by NHS England; or

(b) an application through the online registration service supplied to the contractor by NHS England.

(3A) The contractor must make available both application methods referred to in sub-paragraph (3).

(4) An application may be made—

(a) where the patient is a child, on behalf of the patient by—

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

(ii) a person duly authorised by a local authority to whose care the child has been committed under the Children Act 1989 , or

(iii) a person duly authorised by a voluntary organisation by which the child is being accommodated under the provisions of the Children Act 1989; or

(b) where the patient is an adult who lacks capacity to make such an application, or to authorise such an application to be made on their behalf, by—

(i) a relative of that person,

(ii) the primary carer of that person,

(iii) a donee of a lasting power of attorney granted by that person, or

(iv) a deputy appointed for that person by the court under the provisions of the Mental Capacity Act 2005 .

(5) Where a contractor accepts an application for inclusion in the contractor's list of patients, the contractor must give notice in writing to NHS England of that acceptance as soon as possible.

(6) NHS England must, on receipt of a notice given under sub-paragraph (5)—

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

(b) give notice in writing to the applicant (or, in the case of a child or an adult who lacks capacity, the person making the application on their behalf) of that acceptance.

(7) This paragraph is subject to Part 2A.

Inclusion in list of patients: armed forces personnel

19

(1) The contractor may, if the contractor's list of patients is open, include a person to whom sub-paragraph (2) applies in that list for a period of up to two years and paragraph 29(1)(b) does not apply in respect of any person who is included in the contractor's list of patients by virtue of this paragraph.

(2) This sub-paragraph applies to a person who is—

(a) a serving member of the armed forces of the Crown who has received written authorisation from Defence Medical Service to receive primary medical services from the contractor's practice; and

(b) living or working within the contractor's practice area during the period in respect of which that written authorisation is given.

(3) Where the contractor has accepted a person to whom sub-paragraph (2) applies onto its list of patients, the contractor must—

(a) obtain a copy of the patient's medical record, or a summary of that record, from Defence Medical Services; and

(b) provide regular updates to Defence Medical Services, at such intervals as are agreed with Defence Medical Services, about any care and treatment which the contractor has provided to the patient.

(4) At the end of the period of two years, or on such earlier date as the contractor's responsibility for the patient has come to an end, the contractor must—

(a) notify Defence Medical Services in writing that its responsibility for the patient has come to an end; and

(b) update the patient's medical record, or summary of that record, and return it to Defence Medical Services.

Temporary residents

20

(1) The contractor may, if the contractor's list of patients is open, accept a person as a temporary resident provided the contractor is satisfied that the person is—

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

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

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

(3) Where a contractor wants to terminate its responsibility for a person accepted by it as a temporary resident before the end of—

(a) three months; or

(b) such shorter period for which the contractor agreed to accept that person as a temporary resident,

the contractor must give notice of that fact to the person either orally or in writing and the contractor's responsibility for that person is to cease seven days after the date on which notice is given.

(4) Where the contractor's responsibility for a person as a temporary resident comes to an end, the contractor must give notice in writing to NHS England of its acceptance of that person as a temporary resident—

(a) at the end of the period of three months beginning with the date on which the contractor accepted that person as a temporary resident; or

(b) if the contractor's responsibility for that person as a temporary resident came to an end earlier than at the end of the three month period referred to in paragraph (a), at the end of that period.

(5) This paragraph is subject to Part 2A.

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

21

(1) The contractor may only refuse an application made under paragraph 18 or 20 if the contractor has reasonable grounds for doing so which do not relate to the applicant's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class.

(2) The reasonable grounds referred to in sub-paragraph (1) may, in the case of an application made under paragraph 18, include the ground that the applicant—

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

(b) lives in the outer boundary area (the area referred to in regulation 20(3)).

(3) Where a contractor refuses an application made under paragraph 18 or 20, the contractor must give notice in writing of that refusal and the reasons for it to the applicant (or, in the case of a child or an adult who lacks capacity, to the person who made the application on their behalf) before the end of the period of 14 days beginning with the date of its decision to refuse.

(4) The contractor must—

(a) keep a written record of—

(i) the refusal of any application made under paragraph 18, and

(ii) the reasons for that refusal; and

(b) make such records available to NHS England on request.

Patient preference of a practitioner

22

(1) Where the contractor has accepted an application made under paragraph 18, 20, 32D, 32E, 32F or 32G, the contractor must—

(a) give notice in writing to the person (or, in the case of a child or an adult who lacks capacity, to the person who made the application on the applicant's behalf) of that person's right to express a preference to receive services from a particular performer or class of performer either generally or in relation to any particular condition; and

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

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

(a) has reasonable grounds for refusing to provide services to the person who expressed the preference; or

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

Removal from the list at the request of the patient

23

(1) The contractor must give notice in writing to NHS England of a request made by any person who is a registered patient to be removed from the contractor's list of patients.

(2) Where NHS England—

(a) receives a notice given by the contractor under sub-paragraph (1); or

(b) receives directly a request from a person to be removed from the contractor's list of patients,

Removal from the list at the request of the patient

24

(1) Subject to paragraph 25, where a contractor has reasonable grounds for wanting a person to be removed from its list of patients which do not relate to the person's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class the contractor must—

(a) give notice in writing to NHS England that it wants to have that person removed; and

(b) subject to sub-paragraph (2), give notice in writing to that person of its specific reasons for requesting the removal of that person.

(2) Where, in the reasonable opinion of the contractor—

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

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

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

(3) Except in the circumstances specified in sub-paragraph (4), a contractor may only request the removal of a person from its list of patients under sub-paragraph (1) if, before the end of the period of 12 months beginning with the date of the contractor's request to NHS England, the contractor has—

(a) warned that person of the risk of being removed from that list; and

(b) explained to that person the reasons for this.

(4) The circumstances specified in this sub-paragraph are that—

(a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

(i) be harmful to the person's physical or mental health, or

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

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

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

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

(c) in the case of a contract with a company limited by shares, a person who is both a legal and beneficial owner of shares in that company;

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

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

(f) any other person present—

(i) on the practice premises, or

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

(6) The contractor must keep a written record—

(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 person concerned; or

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

(7) The contractor must keep a written record of the removal of any person from its list of patients under this paragraph which must include—

(a) the reason given for the removal;

(b) the circumstances of the removal; and

and the contractor must make this record available to NHS England on request.

(8) The removal of a person from the contractor's list of patients must, subject to sub-paragraph (9), take effect from whichever is the earlier of—

(a) the date on which NHS England is given notice of the registration of that person with another provider of essential services (or their equivalent); or

(b) the eighth day after NHS England is given notice under sub-paragraph (1)(a).

(9) Where, on the date on which the removal of a person would take effect under sub-paragraph (8), the contractor is treating that person at intervals of less than seven days, the contractor must give notice in writing to NHS England of that fact and the removal is to take effect on whichever is the earlier of—

(a) the eighth day after NHS England is given notice by the contractor that the person no longer needs such treatment; or

(b) the date on which NHS England is given notice of the registration of the person with another provider of essential services (or their equivalent).

(10) NHS England must give notice in writing to—

(a) the person in respect of whom the removal is requested; and

(b) the contractor,

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

Removal from the list of patients who are violent

25

(1) Where a contractor wants a person to be removed from its list of patients with immediate effect on the grounds that—

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

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

the contractor must give notice to NHS England in accordance with sub-paragraph (3).

(1A) Subject to sub-paragraph (1B), where a contractor—

(a) accepts a person onto its list of patients; and

(b) subsequently becomes aware that the person has previously been removed from the list of patients of another provider of primary medical services in response to a request for removal under paragraph (1),

the contractor may give notice to NHS England in accordance with sub-paragraph (3) that it wants to have the person removed from its list of patients with immediate effect.

(1B) A contractor must not give notice to NHS England pursuant to sub-paragraph (1A), where—

(a) a person mentioned in paragraph (1A) was allocated to a Violent Patient Scheme ... to receive primary medical services under that scheme, and

(b) the provider of the Scheme discharged that person because they were not considered to pose a risk of violence, or

(2) The persons specified in this sub-paragraph are—

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

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

(c) in the case of a contract with a company limited by shares, a person who is both a legal and beneficial owner of shares in that company;

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

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

(f) any other person present—

(i) on the contractor's practice premises, or

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

(2A) For the purposes of sub-paragraph (1A), any reference to “the contractor” in sub-paragraph (2) is to be read as a reference to the other provider of primary medical services referred to in sub-paragraph (1A), and sub-paragraph (2) is to be construed accordingly.

(2B) In sub-paragraph (1B) “Violent Patient Scheme” means a scheme set up in accordance with the Primary Medical Services (Directed Enhanced Services) Directions to provide primary medical services to those removed from a contractor’s list of patients under paragraph (1).

(3) Notice under sub-paragraph (1) or (1A) may be given by any means but, if not in writing, must subsequently be confirmed in writing before the end of a period of seven days beginning with the date on which notice was given.

(4) NHS England must acknowledge in writing receipt of a request for removal from the contractor under sub-paragraph (1) or (1A).

(5) A removal requested in accordance with sub-paragraph (1) or (1A) takes effect at the time at which the contractor—

(a) makes a telephone call to NHS England; or

(b) sends or delivers the notice to NHS England.

(6) Where, under this paragraph, the contractor has given notice to NHS England that it wants to have a person removed from its list of patients, the contractor must inform that person of that fact unless—

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

(b) the contractor has reasonable grounds for believing that to do so would—

(i) be harmful to that person's physical or mental health, or

(ii) put the safety of any person specified in sub-paragraph (2) at risk.

(7) Where a person is removed from the contractor's list of patients under this paragraph, NHS England must give that person notice in writing of that removal.

(8) The contractor must record the removal of any person from its list of patients under this paragraph and the circumstances leading to that removal in the medical records of the person removed.

Removal from the list of patients registered elsewhere

26

(1) NHS England must remove a person from the contractor's list of patients if—

(a) the person has subsequently been registered with another provider of essential services (or their equivalent) in England; or

(b) NHS England has been given notice by a Local Health Board, a Health Board or a Health and Social Services Board that the person has subsequently been registered with a provider of essential services (or their equivalent) outside of England.

(2) A removal in accordance with sub-paragraph (1) takes effect—

(a) on the date on which NHS England is given notice of the person's registration with the new provider; or

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

(3) NHS England must give notice in writing to the contractor of any person removed from its list of patients under sub-paragraph (1).

Removal from the list of patients who have moved

27

(1) Subject to sub-paragraph (2), where NHS England is satisfied , or is notified by the contractor, that a person on the contractor's list of patients has moved and no longer resides in the contractor's practice area, NHS England must—

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

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

(c) inform the person that if, after the end of the period of 30 days beginning with the date on which the advice mentioned in paragraph (b) was given, that person has not acted in accordance with that advice and informed NHS England accordingly, that person will be removed from the contractor's list of patients.

(2) If, at the end of the period of 30 days mentioned in sub-paragraph (1)(c), NHS England has not been informed by the person of the action taken, NHS England must remove that person from the contractor's list of patients and inform that person and the contractor of that removal.

Removal from the list of patients whose address is unknown

28

Where the address of a person who is on the contractor's list of patients is no longer known to NHS England, NHS England must—

(a) give notice in writing to the contractor that it intends, at the end of the period of three months beginning with the date on which the notice was given, to remove the person from the contractor's list of patients; and

(b) at the end of the period referred to in sub-paragraph (a), remove the person from the contractor's list of patients unless, before the end of that period, the contractor satisfies NHS England that the person is a patient to whom it is still responsible for providing essential services.

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

29

(1) NHS England must remove a person from a contractor's list of patients where it receives notice to the effect that the person—

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

(b) is in the armed forces of the Crown (except in the case of a patient to which paragraph 19 applies);

(c) is serving a term of imprisonment of more than two years or more than one term of imprisonment totalling, in the aggregate, more than two years;

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

(e) has died.

(2) The removal of a person from a contractor's list of patients under this paragraph takes effect from—

(a) where sub-paragraph (1)(a) to (c) applies—

(i) the date of the person's departure, enlistment or imprisonment, or

(ii) the date on which NHS England first receives notice of the person's departure, enlistment or imprisonment,

whichever is the later; or

(b) where sub-paragraph (1)(d) and (e) applies, the date on which NHS England is given notice of the person's absence or death.

(3) NHS England must give notice in writing to the contractor of the removal of any person from the contractor's list of patients under this paragraph.

Removal from the list of patients accepted elsewhere as temporary residents

30

(1) NHS England must remove a person from a contractor's list of patients where the person has been accepted as a temporary resident by another contractor or other provider of essential services (or their equivalent) in any case where NHS England is satisfied, after due inquiry, that—

(a) the person's stay in the place of temporary residence has exceeded three months; and

(b) the person has not returned to their normal place of residence or to any other place within the contractor's practice area.

(2) NHS England must give notice in writing of the removal of a person from a contractor's list of patients under this paragraph—

(a) to the contractor; and

(b) where practicable, to that person.

(3) A notice given under sub-paragraph (2)(b) must inform the person of—

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

(b) the name, postal and electronic mail address and telephone number of NHS England.

Removal from the list of pupils etc. of a school

31

(1) Where the contractor provides essential services under the contract to persons on the grounds that they are pupils at, or staff or residents of, a school, NHS England must remove any person from a contractor's list of patients who does not appear on the particulars provided by that school of persons who are pupils at, or staff or residents of, that school.

(2) Where NHS England has requested a school to provide the particulars referred to in sub-paragraph (1) and has not received those particulars, NHS England must consult the contractor as to whether it should remove from the contractor's list of patients any persons appearing in that list as pupils at, or staff or residents of, that school.

(3) NHS England must give notice in writing to the contractor of the removal of any person from the contractor's list of patients under this paragraph.

Termination of responsibility for patients not registered with the contractor

32

(1) Where the contractor has—

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

(i) from a person who is not included in the contractor's list of patients,

(ii) from a person that the contractor has not accepted as a temporary resident, or

(iii) made on behalf of a person referred to in paragraph (i) or (ii) by a person specified in paragraph 18(4); and

(b) accepted the person making the application or on whose behalf the application is made as a patient for the provision of the service in question,

the contractor's responsibility for that person terminates in the circumstances described in sub-paragraph (2).

(2) The circumstances described in this sub-paragraph are that—

(a) the contractor is informed that the person no longer wishes the contractor to be responsible for the provision of the service in question;

(b) in a case where the contractor has reasonable grounds for terminating its responsibility to provide the service to the person which do not relate to the person's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class, the contractor informs the person that it no longer wants to be responsible for providing that person with the service in question; or

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

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

(3) Where a contractor wants to terminate its responsibility for a person under sub-paragraph (2)(b), the contractor must give notice to that person of the termination and the reason for it.

(4) The contractor must keep a written record of terminations under this paragraph and of the reasons for those terminations and must make this record available to NHS England on request.

(5) A termination under sub-paragraph (2)(b) takes effect—

(a) where the grounds for termination are those specified in paragraph 25(1), from the date on which the notice is given; or

(b) in any other case, 14 days after the date on which the notice is given.

PART 3 — Lists of patients: closure etc.

Application for closure of list of patients

33

(1) Where a contractor wants to close its list of patients, the contractor must send a written application to that effect (“the application”) to NHS England.

(2) The application must include the following information—

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

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

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

(d) the period of time, being a period of not less than three months and not more than 12 months, during which the contractor wants its list of patients to be closed;

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

(f) any plans which the contractor may have to alleviate the difficulties mentioned in the application during the period of the proposed closure in order for that list to re-open at the end of that period without the existence of those difficulties; and

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

(3) NHS England must acknowledge receipt of the application before the end of the period of seven days beginning with the date on which NHS England received the application.

(4) NHS England must consider the application and may request such other information from the contractor as NHS England requires in order to enable it to determine the application.

(5) NHS England must enter into discussions with the contractor concerning—

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

(b) any changes which NHS England or the contractor may make,

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

(6) NHS England and the contractor must, throughout the period of the discussions referred to in sub-paragraph (5), use reasonable endeavours to achieve the aim of keeping the contractor's list of patients open.

(7) NHS England or the contractor may, at any stage during the discussions, invite the Local Medical Committee (if any) for the area in which the contractor provides services under the contract to attend any meetings arranged between NHS England and the contractor to discuss the application.

(8) NHS England may consult such persons as it appears to NHS England may be affected by the closure of the contractor's list of patients and, if NHS England does so, it must provide to the contractor a summary of the views expressed by those persons consulted in respect of the application.

(9) NHS England must enable the contractor to consider and comment on all the information before NHS England makes a decision in respect of the application.

(10) A contractor may withdraw the application at any time before NHS England makes a decision in respect of that application.

(11) NHS England must, before the end of the period of 21 days beginning with the date on which the application was received by NHS England (or within such longer period as the parties may agree), make a decision to—

(a) approve the application and determine the date from which the closure of the contractor's list is to take effect; or

(b) reject the application.

(12) NHS England must give notice in writing to the contractor of its decision to—

(a) approve the application in accordance with paragraph 34; or

(b) reject the application in accordance with paragraph 35.

(13) A contractor may not submit more than one application to close its list of patients in any period of 12 months beginning with the date on which NHS England makes its decision on the application unless—

(a) paragraph 36 applies; or

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

Approval of an application to close a list of patients

34

(1) Where NHS England approves an application to close a contractor's list of patients, NHS England must—

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

(b) at the same time as NHS England gives notice to the contractor, send a copy of the closure notice to—

(i) the Local Medical Committee (if any) for the area in which the contractor provides services under the contract, and

(ii) any person who NHS England consulted in accordance with paragraph 33(8).

(2) The closure notice must include—

(a) the period of time for which the contractor's list of patients is to be closed which must be—

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