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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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(i) the period specified in the application, or

(ii) where NHS England and the contractor have agreed in writing to a different period, that different period,

and, in either case, the period must not be less than three months and not more than 12 months;

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

(3) Subject to paragraph 37, a contractor must close its list of patients with effect from the closure date and the list of patients must remain closed for the duration of the closure period as specified in the closure notice.

Rejection of an application to close a list of patients

35

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

(a) give notice in writing to the contractor of its decision as soon as possible, including NHS England's reasons for rejecting the application; and

(b) at the same time as it gives notice to the contractor, send a copy of the 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) Subject to sub-paragraph (3), if NHS England rejects an application from a contractor to close its list of patients, the contractor must not make a further application to close its list of patients until whichever is the later of—

(a) the end of the period of three months beginning with the date on which NHS England's decision to reject the application was made; or

(b) in a case where a dispute arising from NHS England's decision to reject the application has been referred to the NHS dispute resolution procedure, the end of the period of three months beginning with the date on which a final determination to reject the application was made in accordance with that procedure (or any court proceedings).

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

Application for an extension of a closure period

36

(1) A contractor may apply to extend the closure period by sending a written application (“the application”) to that effect to NHS England no later than eight weeks before the date on which the closure period is due to expire.

(2) The application must include the following information—

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

(b) the period of time during which the contractor wants its list of patients to remain closed (which may not be longer than 12 months);

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

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

(e) 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 it requires in order to enable it to decide the application.

(5) NHS England may 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 re-open its list of patients.

(6) NHS England must determine the application before the end of the period of 14 days beginning with the date on which NHS England received that application (or before the end of such longer period as the parties may agree).

(7) NHS England must give notice in writing to the contractor of its decision to approve or reject the application to extend the closure period as soon as possible after making that decision.

(8) Where NHS England approves an application, NHS England must—

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

(b) at the same time as it gives notice in writing to the contractor, send a copy of the extended 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).

(9) The extended closure notice must include—

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

(i) the period specified in the application, or

(ii) where NHS England and contractor have agreed in writing a different period to the period specified in that application, that agreed period,

and, in either case, the period (“the extended closure period”) must not be less than three months and not more than 12 months beginning with the date on which the extended closure period is to take effect;

(b) the date on which the extended closure period is to take effect; and

(10) Where NHS England rejects an application, it must—

(a) give notice in writing to the contractor of its decision including its reasons for rejecting the application; and

(b) at the same time as it gives notice to the contractor, send a copy of the notice to the Local Medical Committee (if any) for the area in which the contractor provides services under the contract.

(11) Where an application is made in accordance with sub-paragraphs (1) and (2), the contractor's list of patients is to remain closed pending whichever is the later of—

(a) the determination by NHS England of that application; or

(b) in a case where a dispute arising from NHS England's decision to reject the application to extend the closure period has been referred to the NHS dispute resolution procedure, the contractor ceasing to pursue that dispute through that procedure (or any court proceedings).

Re-opening of list of patients

37

The contractor may re-open its list of patients before the expiry of the closure period if NHS England and the contractor agree that the contractor should do so.

PART 4 — Assignment of patients to lists

Application of this Part

38

(1) This Part applies in respect of the assignment by NHS England of—

(a) a person as a new patient to a contractor’s list of patients where that person—

(i) has been refused inclusion in a contractor’s list of patients or has not been accepted as a temporary resident by a contractor, and

(ii) would like to be included in the list of patients of a contractor in whose integrated care board area that person resides; or

(b) any person who is part of a list dispersal resulting from the closure of a practice where that person—

(i) has not registered with another contractor, and

(ii) would like to be included in the list of patients of a contractor in whose integrated care board area that person resides; or

(c) any person who is part of a list dispersal resulting from the closure of a practice where that person has not registered with another contractor and NHS England has been unable to contact that person.

(2) In this paragraph, “list dispersal” means the allocation of patients from a contractor’s list of patients by NHS England following termination of the contract or during the period set out in the notice of termination or agreement to terminate.

Assignment of patients to list of patients: open and closed lists

39

(1) Subject to paragraph 40, NHS England may—

(a) assign a new patient to a contractor whose list of patients is open; and

(b) only assign a new patient to a contractor whose list of patients is closed in the circumstances specified in sub-paragraph (2).

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

(a) the assessment panel has determined under paragraph 41(7) that new patients may be assigned to the contractor in question, and that determination has not been overturned either by a determination of the Secretary of State under paragraph 42(13) or (where applicable) by a court; and

(b) NHS England has entered into discussions with the contractor in question regarding the assignment of new patients if such discussions are required under paragraph 43.

Factors relevant to assignments

40

When assigning a person as a new patient to a contractor's list of patients under paragraph 39(1)(a) or (b), NHS England must have regard to—

(a) the preferences and circumstances of the person;

(b) the distance between the person's place of residence and the contractor's practice premises;

(c) any request made by a contractor to remove the person from its list of patients within the preceding period of six months beginning with the date on which the application for assignment is received by NHS England;

(d) whether, during the preceding period of six months beginning with the date on which the application for assignment is received by NHS England, the person has been removed from a list of patients on the grounds referred to in—

(i) paragraph 24 (relating to the circumstances in which a person may be removed from a contractor's list of patients at the request of the contractor),

(ii) paragraph 25 (relating to the removal from the contractor's list of patients of persons who are violent), or

(iii) the equivalent provisions to those paragraphs in relation to arrangements made under section 83(2) of the Act or section 92 of the Act (which relate to arrangements for the provision of primary medical services);

(e) in a case to which sub-paragraph (d)(ii) applies (or equivalent provisions as mentioned in sub-paragraph (d)(iii) apply), whether the contractor has appropriate facilities to deal with such patients; and

(f) such other matters as NHS England considers relevant.

Assignments to closed lists: composition and determinations of the assessment panel

41

(1) Where NHS England wants to assign a new patient to a contractor which has closed its lists of patients, NHS England must prepare a proposal to be considered by the assessment panel.

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

(a) contractors, including those contractors who provide primary medical services under arrangements made under section 83(2) of the Act or 92 of the Act (which relate to arrangements for the provision of primary medical services) which—

(i) have closed their lists of patients, and

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

(b) the Local Medical Committee (if any) for the area in which the contractors referred to in paragraph (a) provide essential services (or their equivalent),

that it has referred the matter to the assessment panel.

(3) NHS England must ensure that the assessment panel is appointed to consider and determine the proposal made under sub-paragraph (1), and the composition of the assessment panel must be as described in sub-paragraph (4).

(4) The members of the assessment panel must be—

(a) a member of NHS England who is a director;

(b) a patient representative who is a member of the Local Health and Wellbeing Board or Local Healthwatch organisation ;

(c) a member of a Local Medical Committee, but not a member of the Local Medical Committee (if any) for the area in which the contractors who may be assigned patients as a consequence of the assessment panel's determination provide services.

(5) In reaching its determination, the assessment panel must have regard to all relevant factors including—

(a) whether NHS England has attempted to secure the provision of essential services (or their equivalent) for new patients other than by means of assignment to a contractor with a closed list; and

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

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

(7) The assessment panel must—

(a) determine whether NHS England may assign new patients to a contractor which has a closed list of patients; and

(b) if it determines that NHS England may make such an assignment, determine, where there is more than one contractor, the contractors to which patients may be assigned.

(8) The assessment panel may determine that NHS England may assign new patients to contractors other than any of the contractors specified in its proposals under sub-paragraph (1), as long as the contractors were given notice in writing under sub-paragraph (2)(a).

(9) The assessment panel's determination must include its comments on the matters referred to in sub-paragraph (5), and notice in writing of that determination must be given to those contractors referred to in sub-paragraph (2)(a).

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

42

(1) Where an assessment panel makes a determination under paragraph 41(7)(a) that NHS England may assign new patients to contractors who have closed their lists of patients, any contractor specified in the determination may refer the matter to the Secretary of State to review that determination.

(2) Where a matter is referred to the Secretary of State under sub-paragraph (1), it must be reviewed in accordance with the procedure specified in the following sub-paragraphs.

(3) Where more than one contractor specified in the determination would like to refer the matter for dispute resolution, those contractors may, if they all agree, refer the matter jointly and, in that case, the Secretary of State must review the matter in relation to those contractors together.

(4) The contractor (or contractors) must send to the Secretary of State, before the end of the period of seven days beginning with the date of the determination of the assessment panel in accordance with paragraph 41(7), 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 (or contracts); and

(5) The Secretary of State must, before the end of the period of seven days beginning with the date on which the matter was referred to the Secretary of State—

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

(b) include with the notice a written request to the parties to make, in writing before the end of a specified period, any representations which those parties would like to make about the dispute.

(6) The Secretary of State must give, with the notice under sub-paragraph (5), to the party other than the one which referred the matter to dispute resolution, a copy of any document by which the dispute was referred to dispute resolution.

(7) The Secretary of State must, upon receiving any representations from a party—

(a) give a copy of those representations to each other party; and

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

(8) The Secretary of State may—

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

(b) consult other persons whose expertise the Secretary of State considers is likely to assist the Secretary of State's consideration of the dispute.

(9) Where the Secretary of State consults another person under sub-paragraph (8)(b), the Secretary of State must—

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

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

(10) In considering the dispute, the Secretary of State must take into account—

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

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

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

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

(11) Subject to the other provisions of this paragraph and to any agreement between the parties, the Secretary of State may determine the procedure which is to apply to the dispute resolution in such manner as the Secretary of State considers appropriate in order to ensure the just, expeditious, economical and final determination of the dispute.

(12) In this paragraph, “specified period” means—

(a) such period as the Secretary of State specifies in the request being a period of not less than one week and not more than two 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 for the determination of the dispute where the period for determination of the dispute has been extended in accordance with sub-paragraph (16), and where the Secretary of State does so allow, a reference in this paragraph to the specified period is to the period as so extended.

(13) Subject to sub-paragraph (16), the Secretary of State must—

(a) determine the dispute before the end of the period of 21 days beginning with the date on which the matter was referred to the Secretary of State;

(b) determine whether NHS England may assign new patients to contractors which have closed their lists of patients; and

(c) if the Secretary of State determines that NHS England may assign new patients to such contractors, determine the contractors to which such new patients may be assigned.

(14) The Secretary of State must not determine that patients may be assigned to a contractor which was not specified in the determination of the assessment panel under paragraph 41(7)(b).

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

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

(a) the Secretary of State;

(b) NHS England; and

(17) The Secretary of State must—

(a) record the determination, and the reasons for it, in writing; and

(b) give notice in writing of the determination (including the record of the reasons) to the parties.

Assignments to closed lists: assignments of patients by the Board

43

(1) Before NHS England assigns a new patient to a contractor, NHS England must, subject to sub-paragraph (3)—

(a) enter into discussions with the contractor regarding the additional support that NHS England can offer the contractor; and

(b) use its best endeavours to provide such appropriate support.

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

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

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

(b) to any subsequent assignment to that contractor to the extent that it is reasonable and appropriate having regard to—

(i) the numbers of patients who have been or may be assigned to it, and

(ii) the period of time since the last discussions under sub-paragraph (1)(a) took place.

PART 5 — Sub-contracting

Sub-contracting of clinical matters

44

(1) Subject to sub-paragraph (2), the contractor must not sub-contract any of its rights or duties under the contract in relation to clinical matters to any person unless—

(a) in all cases, including those duties relating to out of hours services to which paragraph 45 applies, it has taken reasonable steps to satisfy itself that—

(i) it is reasonable in all the circumstances to do so, and

(ii) the person to whom any of those rights or duties is sub-contracted is qualified and competent to provide the service; and

(b) except in cases to which paragraph 45 applies, the contractor has given notice in writing to NHS England of its intention to sub-contract as soon as reasonably practicable before the date on which the proposed sub-contract is intended to come into effect.

(2) Sub-paragraph (1)(b) does not apply to a contract for services with a health care professional for the provision by that professional personally of clinical services.

(3) A notice given under sub-paragraph (1)(b) must include—

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

(b) the duration of the proposed sub-contract;

(d) the address of any premises to be used as practice premises under the proposed sub-contract.

(4) On receipt of a notice given under sub-paragraph (1)(b), NHS England may request such further information relating to the proposed sub-contract as appears to it to be reasonable and the contractor must supply such information to NHS England promptly.

(5) The contractor must not proceed with a sub-contract or, if the sub-contract has already taken effect, the contractor must take steps to terminate it, where—

(a) NHS England gives notice in writing of its objection to the sub-contract on the grounds that the sub-contract would—

(i) put the safety of the contractor's patients at serious risk, or

(ii) put NHS England at risk of material financial loss,

and notice is given by NHS England before the end of the period of 28 days beginning with the date on which NHS England received a notice from the contractor under sub-paragraph (1)(b); or

(b) the sub-contractor would be unable to meet the contractor's obligations under the contract.

(6) A notice given by NHS England under sub-paragraph (5)(a) must include a statement of the reasons for NHS England's objection.

(7) Sub-paragraphs (1) and (3) to (6) also apply in relation to any renewal or material variation of a sub-contract in relation to clinical matters.

(8) Where NHS England does not give notice of an objection under sub-paragraph (5), the parties to the contract are deemed to have agreed a variation of the contract which has the effect of adding to the list of practice premises any premises the address of which was notified to NHS England under sub-paragraph (3)(d) and, in these circumstances, paragraph 57(1) of Schedule 3 does not apply.

(9) Subject to sub-paragraph (9A), a sub-contract entered into by a contractor must prohibit the sub-contractor from sub-contracting any of the clinical services that it has agreed with the contractor to provide under the sub-contract.

(9A) A sub-contract entered into by the contractor may allow the sub-contractor to sub-contract clinical services the contractor has agreed to provide under the Network Contract Directed Enhanced Service Scheme, pursuant to the Primary Medical Services (Directed Enhanced Services) Directions, provided the contractor obtains the written approval of NHS England prior to the sub-contractor sub-contracting those services.

(10) The contractor must not sub-contract any of its rights or duties under the contract in relation to the provision of essential services to a company or firm that is—

(a) wholly or partly owned by the contractor, or by any former or current employee of, or partner or shareholder in, the contractor;

(b) formed by or on behalf of the contractor, or from which the contractor derives or may derive a pecuniary benefit; or

(c) formed by or on behalf of a former or current employee of, or partner or shareholder in, the contractor, or from which such a person derives or may derive a pecuniary benefit,

where sub-paragraph (11) applies to that company or firm.

(11) This sub-paragraph applies to a company or firm which is or was formed wholly or partly for the purpose of avoiding the restrictions on the sale of goodwill of a medical practice in section 259 of the Act (sale of medical practices), and Schedule 21 to the Act (prohibition of sale of medical practices), or any regulations made wholly or partly under those provisions of the Act.

Sub-contracting out of hours services

45

(1) A contractor must not sub-contract all or part of its duty to provide out of hours services under the contract to a person other than those specified in sub-paragraph (2) without the prior written approval of NHS England.

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

(a) a person who holds a general medical services contract with NHS England which includes out of hours services;

(b) a section 92 provider who is required to provide the equivalent of essential services to its patients during all or part of the out of hours period;

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

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

(3) The requirement in sub-paragraph (1) to obtain prior written approval does not apply in any case where a contractor sub-contracts all or part of its duty to provide out of hours services under the contract on a short term or occasional basis.

(4) An application for approval under sub-paragraph (1) may be made by the contractor in writing to NHS England and must state—

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

(b) the address of any premises to be used as practice premises under the sub-contract;

(d) the services to be covered by the sub-contract; and

(e) the manner in which the sub-contractor proposes to meet the contractor's obligations under the contract in respect of the services to be covered by the sub-contract.

(5) NHS England may request such further information relating to arrangements under the proposed sub-contract as appears to it to be reasonable before the end of the period of seven days beginning with the date on which NHS England received the application under sub-paragraph (4).

(6) Where NHS England receives an application which meets the requirements specified in sub-paragraph (4), or receives any further information requested under sub-paragraph (5) in relation to an application, NHS England must, before the end of the period of 28 days beginning with the date on which it received the application or that information (whichever is the latest)—

(a) approve the application;

(b) approve the application subject to conditions; or

(7) NHS England must not refuse the application if it is satisfied that the arrangements covered by the proposed sub-contract would, in respect of the services to be provided, enable the contractor to satisfactorily meet its obligations under the contract and would not—

(a) put the safety of the contractor's patients at serious risk; or

(b) put NHS England at risk of material financial loss.

(8) NHS England must give notice in writing to the contractor of its decision on the application and, where it refuses an application, it must include in the notice a statement of the reasons for its refusal.

(9) Where NHS England approves an application under this paragraph, the parties to the contract are deemed to have agreed a variation of the contract which has the effect of adding to the list of practice premises, for the purposes of the provision of services in accordance with that application, any premises the address of which was notified to NHS England under sub-paragraph (4)(b) and, in these circumstances, paragraph 57(1) of Schedule 3 does not apply.

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

(11) A sub-contract entered into by a contractor must prohibit the sub-contractor from sub-contracting the out of hours services that it has agreed with the contractor to provide under the sub-contract.

Withdrawal and variation of approval under paragraph 45

46

(1) Subject to paragraph 47, where NHS England approves an application made under paragraph 45, NHS England may subsequently give notice in writing to the contractor withdrawing or varying that approval from a date specified in the notice if it is no longer satisfied that the arrangements covered by the sub-contract would enable the contractor to satisfactorily meet its obligations under the contract.

(2) The date specified in the notice given under sub-paragraph (1) may be such date as appears to NHS England to be reasonable in all the circumstances.

(3) A notice given under sub-paragraph (1) takes effect on whichever is the later of—

(a) the date specified in the notice; or

(b) in a case where a dispute arising in relation to the notice given by NHS England under sub-paragraph (1) is referred to the NHS dispute resolution procedure, the date of the final determination of the dispute under that procedure (or any court proceedings) in favour of NHS England.

(4) This paragraph does not affect any other remedies which NHS England may have under the contract.

Withdrawal or variation of approval with immediate effect

47

(1) Where NHS England approves an application made under paragraph 45, NHS England may subsequently give notice in writing to the contractor withdrawing or varying that approval with immediate effect if NHS England is—

(a) no longer satisfied that the arrangements covered by the sub-contract would enable the contractor to satisfactorily meet its obligations under the contract; and

(b) satisfied that the immediate withdrawal or variation of the approval is necessary to protect the safety of the contractor's patients.

(2) A notice given under sub-paragraph (1) takes effect on the date on which it is received by the contractor.

(3) This paragraph does not affect any other remedies which NHS England may have under the contract.

PART 6 — Provision of information: practice leaflet, use of NHS primary care logo, marketing campaigns and advertising private services

Information to be included in practice leaflets

48

A practice leaflet must include—

(a) the name of the contractor;

(b) the address of each of the contractor's practice premises;

(c) the contractor's telephone and fax number and its website address or the address at which its online practice profile is available;

(d) in the case of a contract with a partnership—

(i) whether or not the partnership is a limited partnership, and

(ii) the names of all the partners in the partnership and, in the case of a limited partnership, the status of the partners as either a general or a limited partner;

(e) in the case of a contract with a company limited by shares—

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

(ii) the address of the company's registered office;

(f) the full name of each person performing services under the contract;

(g) the professional qualifications of each health care professional providing services under the contract;

(h) whether the contractor undertakes the teaching or training of health care professionals or persons intending to become health care professionals;

(i) the contractor's practice area, including the area known as the outer boundary area (within the meaning given by regulation 20(3)) by reference to an image of the practice area, a written description of the practice area or a digital practice area map;

(j) the access arrangements which the contractor's practice premises has for providing services to disabled patients and, if none, the alternative arrangements for providing services to such patients;

(k) how to register as a patient;

(l) information about the assignment by the contractor to its new and existing patients of an accountable GP in accordance with paragraph 8;

(m) information about the assignment by the contractor to its patients aged 75 and over of an accountable GP in accordance with paragraph 11;

(n) the right of patients to express a preference of practitioner in accordance with paragraph 22 and the means of expressing such a preference;

(o) the services available under the contract;

(p) the opening hours of the practice premises and the method of obtaining access to services throughout the core hours;

(q) the criteria for home visits and the method of obtaining such visits;

(r) the consultations available to patients under paragraphs 9 and 10;

(s) the arrangements for services in the out of hours period (whether or not provided by the contractor) and how the patient may access such services;

(t) if services during the out of hours period are not provided by the contractor, the fact that NHS England is responsible for the commissioning of those services;

(u) the method by which patients may obtain repeat prescriptions;

(v) if the contractor offers repeatable prescribing services, the arrangements for providing such services;

(w) if the contractor is a dispensing contractor, the arrangements for dispensing prescriptions;

(x) how patients may make a complaint or comment on the provision of services;

(y) the rights and responsibilities of the patient, including keeping appointments;

(z) the action that may be taken under paragraph 25 where a patient is violent or abusive to the contractor, the contractor's staff, persons present on the practice premises or in the place where treatment is provided under the contract;

(aa) details of who has access to patient information (including information from which the identity of the individual can be ascertained) and the patient's rights in relation to disclosure of such information;

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

PART 7 — Notice requirements and rights of entry

Notices to the Board

49

(1) In addition to any requirements to give notice elsewhere in these Regulations, the contractor must give notice in writing to NHS England as soon as reasonably practicable of—

(a) any serious incident that, in the reasonable opinion of the contractor, affects or is likely to affect the contractor's performance of its obligations under the contract;

(b) any circumstances which give rise to NHS England's right to terminate the contract under paragraph 65, 66 or 67;

(d) any change in the address of a registered patient of which the contractor is aware; and

(e) the death of any patient of which the contractor is aware.

(2) The contractor must give notice in writing to NHS England about any person, other than a registered patient or a person whom the contractor has accepted as a temporary resident, to whom the contractor has provided essential services in the form of immediately necessary treatment as described in regulation 17(7) or (9).

(3) The contractor must give notice to NHS England under sub-paragraph (2) before the end of the period of 28 days beginning with the date on which the services described in that sub-paragraph were provided.

Notice provisions specific to a contract with a company limited by shares

50

(1) Where a contractor is a company limited by shares, the contractor must give notice in writing to NHS England as soon as—

(a) any share in the company is transmitted or transferred (whether legally or beneficially) to another person on a date after the date on which the contract was entered into;

(b) a new director or secretary of the company is appointed;

(c) circumstances arise which may entitle a creditor or a court to appoint a receiver, administrator or administrative receiver in respect of the company;

(d) circumstances arise which would enable the court to make a winding up order in respect of the company;

(e) a company resolution is passed, or a court of competent jurisdiction makes an order, that the company is to be wound up; or

(f) the company is unable to pay its debts within the meaning of section 123 of the Insolvency Act 1986 (definition of inability to pay debts).

(2) A notice under sub-paragraph (1)(a) must confirm that the new shareholder or, as the case may be, the personal representative of a deceased shareholder —

(a) is—

(i) a medical practitioner, or

(ii) a person who satisfies the conditions specified in section 86(2)(b)(i) to (iv) of the Act (persons eligible to enter into GMS contracts); and

(b) meets the further conditions imposed on shareholders by virtue of regulations 5 and 6.

(3) A notice under sub-paragraph (1)(b) must confirm that the new director or, as the case may be, secretary meets the conditions imposed on directors and secretaries by virtue of regulation 6.

Notice provisions specific to a contract with two or more individuals practising in a partnership

51

(1) Where a contractor is a partnership, the contractor must give notice in writing to NHS England as soon as—

(a) any partner in the partnership—

(i) leaves the partnership, or

(ii) informs the other partners in the partnership that they intend to leave the partnership; or

(b) a new partner joins the partnership.

(2) A notice under sub-paragraph (1)(a) must confirm the date on which the partner left or proposes to leave the partnership.

(3) A notice under sub-paragraph (1)(b) must—

(a) state the date on which the new partner joined the partnership;

(b) confirm that the new partner is—

(i) a medical practitioner, or

(ii) a person who satisfies the conditions specified in section 86(2)(b)(i) to (iv) of the Act (persons eligible to enter into GMS contracts);

(d) state whether the new partner is a general or a limited partner in the partnership.

Notice of deaths

52

(1) The contractor must give notice in writing to NHS England of the death on its practice premises of a patient no later than the end of the first working day after the day on which that death occurred.

(2) The notice given under sub-paragraph (1) must include—

(a) the patient's name;

(b) the patient's National Health Service number (where known);

(d) a brief description of the circumstances (as known) surrounding the patient's death;

(e) the name of any medical practitioner or other person treating the patient while the patient was on the contractor's practice premises; and

(f) the name (where known) of any other person who was present at the time of the patient's death.

Notices given to patients following variation of the contract

53

(1) This paragraph applies where a contract is varied in accordance with regulation 29 and Part 8 of this Schedule and, as a result of that variation—

(a) there is to be a change in the range of services provided to the contractor's registered patients; or

(b) patients who are on the contractor's list of patients are to be removed from that list.

(2) Where this paragraph applies, NHS England must—

(a) give notice in writing to those patients of the variation and of its effect; and

(b) inform those patients of the steps that they may take to—

(i) obtain the services in question elsewhere, or

(ii) register elsewhere for the provision to them of essential services (or their equivalent).

Entry and inspection by the Board

54

(1) Subject to the conditions specified in sub-paragraph (2), the contractor must allow any person authorised in writing by NHS England to enter and inspect the contractor's practice premises at any reasonable time.

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

(a) reasonable notice of the intended entry has been given;

(b) written evidence of the authority of the person seeking entry is produced to the contractor on request; and

(c) entry is not made to any premises or part of the premises used as residential accommodation without the consent of the resident.

(3) The contractor or NHS England or a person authorised in writing by NHS England may invite the Local Medical Committee (if any) for the area in which the contractor provides services under the contract to be present at any inspection of the contractor's practice premises which takes place under this paragraph.

Entry and inspection by the Care Quality Commission

55

The contractor must allow persons authorised by the Care Quality Commission to enter and inspect the contractor's practice premises in accordance with section 62 of the Health and Social Care Act 2008 (entry and inspection).

Entry and inspection by Local Healthwatch organisations

56

The contractor must comply with the requirement to allow an authorised representative to enter and view premises and observe the carrying on of activities on those premises in accordance with regulations made under section 225 of the Local Government and Public Involvement in Health Act 2007 (duties of services-providers to allow entry by Local Healthwatch organisations or contractors).

PART 8 — Variation and termination of contracts

Variation: general

57

(1) Subject to Part 6, and to paragraphs 44(8), 45(9), 58, 59 and 72, a variation of, or amendment to, a contract is not effective unless it is made in writing and signed by or on behalf of NHS England and the contractor.

(2) NHS England may vary a contract without the contactor's consent where—

(a) it is reasonably satisfied that the variation is necessary in order to comply with the Act, any regulations made under or by virtue of the Act or any direction given by the Secretary of State under or by virtue of the Act; and

(b) it gives notice in writing to the contractor of the wording of the proposed variation and the date on which that variation is to take effect.

(3) The date on which the proposed variation referred to in sub-paragraph (2)(b) is to take effect must, unless it is not reasonably practicable, be a date which falls at least 14 days after the date on which notice under that sub-paragraph is given to the contractor.

Variation provisions specific to a contract with an individual medical practitioner

58

(1) Where a contractor who is an individual medical practitioner proposes to practise in partnership with one or more persons, the contractor must give notice in writing to NHS England of—

(a) the name of the person or persons with whom the contractor proposes to practise in partnership; and

(b) the date on which the contractor would like to change its status as a contractor from that of an individual medical practitioner to that of a partnership, which must be at least 28 days after the date on which the contractor gives notice to NHS England under this sub-paragraph.

(2) A notice given under sub-paragraph (1) must—

(a) in respect of each person with whom the contractor is proposing to practise in partnership confirm that the person—

(i) is either—

(aa) a medical practitioner, or

(bb) a person who satisfies the conditions specified in section 86(2)(b)(i) to (iv) of the Act (persons eligible to enter into GMS contracts); and

(ii) satisfies the conditions imposed by regulations 5 and 6; and

(b) state whether the partnership is to be a general partnership or a limited partnership and give the names of the limited partners and the general partners in the partnership.

(3) A notice given under sub-paragraph (1) must be signed by the individual medical practitioner and by the person, or each of the persons, with whom the practitioner is proposing to practise in partnership.

(4) The contractor must ensure that any person with whom it is to practise in partnership is bound by the contract, whether by virtue of a partnership deed or otherwise.

(5) If NHS England is satisfied as to the accuracy of the matters specified in a notice given under sub-paragraph (1), NHS England must give notice in writing to the contractor confirming that the contract is to continue with the partnership entered into by the contractor and its partners, from a date that NHS England specifies in the notice.

(6) The date to be specified by NHS England under sub-paragraph (5) is—

(a) the date requested in the notice given by the contractor under sub-paragraph (1); or

(b) where that date is not reasonably practicable, a date that is as close as is reasonably practicable to the requested date.

(7) Where the contractor has given notice to NHS England under sub-paragraph (1), NHS England may vary the contract but only to the extent that NHS England is satisfied is necessary to reflect the change in the status of the contractor from that of an individual medical practitioner to a partnership.

(8) If, under sub-paragraph (7), NHS England proposes to vary the contract, it must include in the notice given to the contractor under sub-paragraph (5) the wording of the proposed variation and the date upon which that variation is to take effect.

Variation provisions specific to a contract with two or more persons practising in partnership

59

(1) Subject to sub-paragraph (4), where a contractor consists of two or more persons practising in partnership and that partnership is terminated or dissolved, the contract may only continue with one or more of the former partners if the conditions in paragraph (1A) are satisfied.

(1A) The conditions are—

(a) that partner is, or those partners are, named in a notice given under sub-paragraph (2);

(b) where one partner is named, that partner is a medical practitioner who satisfies the condition in regulation 5(1)(a);

(i) each of those partners is either a medical practitioner or a person who satisfies the conditions specified in section 86(2)(b) of the Act (persons eligible to enter into GMS contracts); and

(ii) the new partnership satisfies the conditions imposed by regulations 5 and 6; and

(d) the requirements in sub-paragraphs (2) and (3) are met.

(2) A contractor must give notice in writing to NHS England of—

(a) the intention to change its status from that of a partnership to that of an individual medical practitioner; or

(b) the intention to change the composition of the partnership.

(3) A notice given under sub-paragraph (2) must—

(a) specify the date on which the contractor would like to change its status or composition, which must be at least 28 days after the date on which the contractor gives notice to NHS England under sub-paragraph (2);

(b) specify—

(i) where notice is given under paragraph (2)(a) the name of the medical practitioner with whom the contract is to continue;

(ii) where notice is given under paragraph (2)(b) the name and contact details of the partners with whom the contract is to continue; and

(4) Where a contractor consists of two persons practising in partnership and the partnership is terminated or dissolved because one of the partners has died, the remaining partner in the partnership must give notice in writing to NHS England of that death as soon as is reasonably practicable and, in that case, sub-paragraphs (5) and (6) apply.

(5) If the remaining partner in the partnership is a general medical practitioner, the contract is to continue with that general medical practitioner.

(6) If the remaining partner in the partnership is not a general medical practitioner, NHS England—

(a) must enter into discussions with that partner and use reasonable endeavours to reach an agreement to enable the provision of clinical services to continue under the contract;

(b) may, if it considers it appropriate, consult the Local Medical Committee (if any) for the area in which the partnership was providing clinical services under the contract or such other person as NHS England considers necessary;

(c) may, if it considers it appropriate to enable the provision of clinical services under the contract to continue, offer the remaining partner in the partnership reasonable support; and

(d) must give notice to the remaining partner in the partnership if agreement has been reached in accordance with sub-paragraph (7) or, in the event that agreement cannot be reached, in accordance with sub-paragraph (8).

(7) If NHS England reaches an agreement, NHS England must give notice in writing to the remaining partner in the partnership confirming—

(a) the terms upon which NHS England agrees to the contract continuing with that partner including the period, as specified by NHS England, during which the contract is to continue (“the interim period”) and such a period must not exceed six months;

(b) that the partner agrees to the employment or engagement of a general medical practitioner for the interim period to assist in the provision of clinical services under the contract; and

(c) the support, if any, which NHS England is to provide to enable the provision of clinical services under the contract to continue during the interim period.

(8) If—

(a) the remaining partner in the partnership does not wish to employ or engage a medical practitioner;

(b) an agreement in accordance with sub-paragraph (6) cannot be reached; or

(c) the remaining partner in the partnership would like to withdraw from the agreed arrangements at any stage during the interim period,

NHS England must give notice in writing to that partner terminating the contract with immediate effect.

(9) If, at the end of the interim period, the contractor has not entered into partnership with a general medical practitioner who is not a limited partner in the partnership, NHS England must give notice in writing to the contractor terminating the contract with immediate effect.

(10) Where a contractor gives notice to NHS England under sub-paragraph (2) or (4), NHS England must—

(a) acknowledge receipt of the notice in writing; and

(b) in relation to a notice given under sub-paragraph (2), acknowledge receipt of the notice before the date specified in accordance with sub-paragraph (3)(a).

(11) Where a contractor gives notice to NHS England under sub-paragraph (2) or (4), NHS England may vary the contract but only to the extent that it is satisfied is necessary to reflect the change in status of the contractor from that of a partnership to an individual medical practitioner or the change in composition of the partnership.

(12) If NHS England varies the contract under sub-paragraph (11), NHS England must give notice in writing to the contractor of the wording of the proposed variation and the date upon which that variation is to take effect.

(13) In this paragraph “general medical practitioner” has the same meaning as in regulation 5(2).

(14) Sub-paragraphs (5) to (9) do not affect any other right which NHS England may have under the contract to vary or terminate the contract.

Termination by agreement

60

NHS England and the contractor may agree in writing to terminate the contract, and if the parties so agree, they must agree the date upon which that termination is to take effect and any further terms upon which the contract is to be terminated.

Termination on the death of an individual medical practitioner

61

(1) Where the contractor is an individual medical practitioner and the contractor dies, the contract terminates at the end of the period of seven days beginning with the date of the contractor's death unless, before the end of that period sub-paragraph (2) applies.

(2) This sub-paragraph applies where—

(a) NHS England agrees in writing with the contractor's personal representatives that the contract is to continue for a further period, not exceeding 28 days, from the end of the period of seven days; and

(b) the contractor's personal representatives confirm in writing to NHS England that they wish to employ or engage one or more general medical practitioners to assist in the continuation of the provision of clinical services under the contract and, after discussion with NHS England—

(i) NHS England agrees to provide reasonable support which would enable clinical services under the contract to continue,

(ii) NHS England and the contractor's personal representatives agree the terms on which the provision of clinical services can continue,

(iii) NHS England and the contractor's personal representatives agree the period during which clinical services must be provided being a period of not more than 28 days beginning on the day after the end of the period of seven days referred to in sub-paragraph (1).

(3) This paragraph does not affect any other rights to terminate the contract which the contractor may have.

Termination by the contractor

62

(1) A contractor may terminate the contract at any time by giving notice in writing to NHS England.

(2) Where a contractor gives notice to NHS England under sub-paragraph (1), the contract terminates six months after the date on which the notice was given (“the termination date”) unless the termination date does not fall on the last calendar day of a month, in which case the contract terminates instead on the last calendar day of the month in which the termination date falls.

(3) If the contractor is an individual medical practitioner, sub-paragraph (2) applies to the contractor as if the references to “six months” were instead references to “three months”.

(4) This paragraph does not affect any other rights to terminate the contract that the contractor may have.

Late payment notices

63

(1) The contractor may give notice in writing (a “late payment notice”) to NHS England if NHS England has failed to make payments due to the contractor in accordance with any term of the contract regarding prompt payment which has the effect specified in regulation 23(1), and the contractor must specify in the late payment notice the payments that NHS England has failed to make in accordance with that term.

(2) Subject to sub-paragraph (3), the contractor may, at least 28 days after the date on which a late payment notice under sub-paragraph (1) was given, terminate the contract by giving a further written notice to NHS England in the event of NHS England's' continuing failure to make the payments that are due to the contractor as specified in the late payment notice.

(3) Sub-paragraph (4) applies if, following receipt of a late payment notice, NHS England—

(a) refers the matter to the NHS dispute resolution procedure before the end of a period of 28 days beginning with the date on which NHS England received the late payment notice; and

(b) gives notice in writing to the contractor that it has done so before the end of that period.

(4) Where this sub-paragraph applies, the contractor may not terminate the contract under sub-paragraph (2) until—

(a) there has been a final determination of the dispute under the NHS dispute resolution procedure (or by a court) and that determination permits the contractor to terminate the contract; or

(b) NHS England ceases to pursue the NHS dispute resolution procedure,

whichever is the earlier.

(5) This paragraph does not affect any other rights to terminate the contract which the contractor may have.

Termination by the Board: general

64

A contract may only be terminated by NHS England in accordance with the following provisions of this Part.

Termination by the Board for breach of conditions in regulation 5

65

(1) Subject to paragraph (2), NHS England must give notice in writing to the contractor terminating the contract with immediate effect where, in any case, a contractor who is an individual medical practitioner has ceased to be a general medical practitioner.

(2) Where the contractor referred to in sub-paragraph (1) has ceased to satisfy the condition specified in regulation 5(1)(a) by reason of a suspension of the type described in sub-paragraph (7), NHS England is not required to give notice to the contractor under sub-paragraph (1) unless—

(a) the contractor is unable to satisfy NHS England that it has in place adequate arrangements for the provision of clinical services under the contract for so long as the suspension continues; or

(b) NHS England is satisfied that the circumstances of the suspension are such that if the contract is not terminated with immediate effect—

(i) the safety of the contractor's patients would be at serious risk, or

(ii) NHS England would be at risk of material financial loss.

(3) Sub-paragraph (4) applies where—

(a) except in a case to which paragraph 59(4) applies, the contractor consists of two or more persons practising in partnership and the condition specified in regulation 5(1)(b) is no longer satisfied; or

(b) the contractor is a company limited by shares, and the condition specified in regulation 5(1)(c) is no longer satisfied.

(4) Where this sub-paragraph applies, NHS England must—

(a) give notice in writing to the contractor terminating the contract with immediate effect; or

(b) give notice in writing to the contractor confirming that NHS England is prepared to allow the contract to continue, for a period specified by NHS England, in accordance with sub-paragraph (5) (“the interim period”).

(5) The period specified by NHS England under sub-paragraph (4)(b) must not exceed—

(a) six months; or

(b) where the failure of the contractor to continue to satisfy the condition in regulation 5(1)(b) or 5(1)(c), is by reason of a suspension described in sub-paragraph (7), the period for which that suspension continues.

(6) NHS England must, during the interim period and with the consent of the contractor, employ or supply the contractor with one or more general medical practitioners for the interim period to assist the contractor in the provision of clinical services under the contract.

(7) The suspensions described in this sub-paragraph are suspension—

(a) by a Fitness to Practise Panel under—

(i) section 35D of the Medical Act 1983 (functions of a fitness to practise panel) in a health case, other than an indefinite suspension under section 35D(6) of that Act, or

(ii) section 38(1) of the Medical Act 1983 (power to order immediate suspension etc. after a finding of impairment of fitness to practise); or

(b) by a Fitness to Practise Panel or an Interim Orders Panel under section 41A of the Medical Act 1983 (interim orders).

(8) Before deciding which of the options in sub-paragraph (4) to pursue, NHS England must, if it is reasonably practicable to do so, consult the Local Medical Committee (if any) for the area in which the contractor provides services under the contract.

(9) If the contractor does not, in accordance with sub-paragraph (6), consent to NHS England employing or supplying a general medical practitioner during the interim period, NHS England must give notice in writing to the contractor terminating the contract with immediate effect.

(10) If, at the end of the interim period, sub-paragraph (3)(a) or (b) continues to apply to the contractor, NHS England must give notice in writing to the contractor terminating the contract with immediate effect.

(11) In this paragraph—

(a) “health case” has the meaning given in section 35E(4) of the Medical Act 1983 (provisions supplementary to section 35D); and

(b) “general medical practitioner” has the meaning given in regulation 5(2).

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

66

(1) NHS England may give notice in writing to the contractor terminating the contract with immediate effect or from such date as may be specified by NHS England in the notice where sub-paragraph (2) applies.

(2) This sub-paragraph applies if, after the contract was entered into, it comes to NHS England's attention that written information—

(a) provided to NHS England by the contractor before the contract was entered into; or

(b) included in a notice given to NHS England by the contractor under paragraph 50(1)(a) or (b) or 51(1),

relating to the conditions set out in regulations 5 and 6 (and compliance with those conditions) was, when given, untrue or inaccurate in a material respect.

Other grounds for termination by the Board

67

(1) NHS England may give notice in writing to a contractor terminating the contract with immediate effect, or from such date as may be specified in the notice, if sub-paragraph (3) applies to the contractor—

(a) during the existence of a contract; or

(b) if later, on or after the date on which a notice in respect of the contractor's compliance with the condition in regulation 6 was given under paragraph 50(1)(a) or (b) or 51(1).

(2) Sub-paragraph (3) applies—

(a) where the contract is with a general medical practitioner, to that general medical practitioner;

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

(i) the company,

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

(iii) any director or secretary of the company.

(3) This sub-paragraph applies if—

(a) the contractor does not satisfy the conditions prescribed in sections 86(2) or 86(3) of the Act (persons eligible to enter into GMS contracts);

(b) the contractor is the subject of a national disqualification;

(c) subject to sub-paragraph (5), the contractor has been disqualified or suspended (other than by an interim suspension order or direction pending an investigation or a suspension on the grounds of ill health) from practising by a licensing body anywhere in the world;

(d) subject to sub-paragraph (6), the contractor has been dismissed (otherwise than by reason of redundancy) from employment by a health service body unless, before NHS England has given notice to the contractor terminating the contract under this paragraph, the contractor is employed by the health service body from which the contractor was dismissed or by another health service body;

(e) the contractor has been removed from, or refused admission to, a primary care list by reason of inefficiency, fraud or unsuitability (within the meaning of section 151(2), (3) and (4) of the Act respectively) unless the contractor's name has subsequently been included in such a list;

(f) the contractor has been convicted in the United Kingdom of murder;

(g) the contractor has been convicted in the United Kingdom of a criminal offence other than murder and has been sentenced to a term of imprisonment of longer than six months;

(h) subject to sub-paragraph (7), the contractor has been convicted elsewhere of an offence which would, if it were committed in England and Wales constitute murder, and—

(i) the offence was committed on or after 14th December 2001, and

(ii) the contractor was sentenced to a term of imprisonment of longer than six months;

(i) the contractor has been convicted of an offence, referred to in Schedule 1 to the Children and Young Persons Act 1933 (offences against children and young persons, with respect to special provisions of this Act apply), or in Schedule 1 to the Criminal Procedure (Scotland) Act 1995 (offences against children under the age of 17 years to which special provisions apply);

(j) the contractor has at any time been included in—

(i) any barred list within the meaning of the Safeguarding Vulnerable Groups Act 2006 , or

(ii) any barred list within the meaning of the Safeguarding Vulnerable Groups (Northern Ireland) Order 2007 (barred lists),

unless the contractor was removed from the list either on the grounds that it was not appropriate for the contractor to have been included in it or as the result of a successful appeal;

(k) the contractor has, within the period of five years before the signing of the contract, been removed from the office of charity trustee or trustee for a charity by an order made by the Charity Commission, the Charity Commission for Northern Ireland or the High Court, and that order was made on the grounds of misconduct or mismanagement in the administration of a charity for which the contractor was responsible or to which the contractor was privy, or which was contributed to, or facilitated by, the contractor's conduct;

(l) the contractor has, within the period of five years before the signing of the contract or commencement of the contract (whichever is earlier), been removed from being concerned with the management or control of a body in any case where removal was by virtue of section 34(5)(e) of the Charities and Trustees Investment (Scotland) Act 2005 (powers of Court of Session); or

(m) the contractor—

(i) has been made bankrupt and has not been discharged from the bankruptcy or the bankruptcy order has not been annulled, or

(ii) has had sequestration of the contractor's estate awarded and has not been discharged from the sequestration;

(n) the contractor is the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986 (bankruptcy restrictions order and undertaking), or Schedule 2A to the Insolvency (Northern Ireland) Order 1989 (bankruptcy restrictions order and undertaking) or sections 56A to 56K of the Bankruptcy (Scotland) Act 1985 (bankruptcy restrictions order, interim bankruptcy restrictions order and bankruptcy restrictions undertaking), unless the contractor has been discharged from that order or that order has been annulled;

(o) the contractor—

(i) is subject to a moratorium period under a debt relief order under Part VIIA of the Insolvency Act 1986 (debt relief orders) applies, or

(ii) is the subject of a debt relief restrictions order or an interim debt relief restrictions order under Schedule 4ZB to that Act (debt relief restrictions orders and undertakings), unless that order has ceased to have effect or has been annulled;

(p) the contractor has made a composition agreement or arrangement with, or a trust deed has been granted for, the contractor's creditors and the contractor has not been discharged in respect of it;

(q) the contractor is a company which has been wound up under Part IV of the Insolvency Act 1986 (winding up of companies registered under the Companies Acts);

(r) the contractor has had an administrator, administrative receiver or receiver appointed in respect of it;

(s) the contractor has had an administration order made in respect of the contractor under Schedule B1 to the Insolvency Act 1986 (administration);

(t) the contractor is a partnership and—

(i) a dissolution of the partnership is ordered by any competent court, tribunal or arbitrator, ...

(ii) an event happens that makes it unlawful for the business of the partnership to continue, or for members of the partnership to carry on in partnership , or

(iii) the partnership has dissolved in circumstances where sub-paragraph (i) and paragraph 59(4) do not apply and none of the former members of the partnership has been named in a notice given under paragraph 59(2) to continue the contract in accordance with paragraph 59(1);

(u) the contractor is subject to—

(i) a disqualification order under section 1 of the Company Directors Disqualification Act 1986 (disqualification orders: general) or a disqualification undertaking under section 1A of that Act (disqualification undertakings: general),

(ii) a disqualification order or disqualification undertaking under article 3 (disqualification orders) or article 4 (disqualification undertakings: general) of the Company Directors Disqualification (Northern Ireland) Order 2002 , or

(iii) a disqualification order under section 429(2) of the Insolvency Act 1986 (disabilities on revocation of administration order against an individual);...

(v) the contractor has refused to comply with a request by NHS England for the contractor to be medically examined because NHS England is concerned that the contractor is incapable of adequately providing services under the contract and, in a case where the contract is with two or more individuals practising in partnership or with a company, NHS England is satisfied that the contractor is taking adequate steps to deal with the matter; or

(w) the contractor’s registration with the Care Quality Commission has been cancelled in accordance with section 17(1) of the Health and Social Care Act 2008, and that cancellation is the final decision of the Commission, or, where an appeal has been launched, is the outcome of that appeal.

(4) NHS England must not terminate the contract under sub-paragraph (3)(c) where NHS England is satisfied that the disqualification or suspension imposed by a licensing body outside the United Kingdom does not make the person unsuitable to be—

(a) a contractor;

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

(i) a person legally and beneficially holding a share in the company, or

(ii) a director or secretary of the company,

as the case may be.

(5) NHS England may not terminate the contract under sub-paragraph (3)(d)—

(a) until a period of at least three months has elapsed since the date of the dismissal of the person concerned; or

(b) if, during the period specified in paragraph (a), the person concerned brings proceedings in any competent tribunal or court in respect of the person's dismissal, until proceedings before that tribunal or court are concluded,

and NHS England may only terminate the contract at the end of the period specified in paragraph (b) if there is no finding of unfair dismissal at the end of those proceedings.

(6) NHS England must not terminate the contract under sub-paragraph (3)(h) where NHS England is satisfied that the conviction does not make the person unsuitable to be—

(a) a contractor;

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

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

(ii) a director or secretary of the company,

as the case may be.

Termination by the Board where patients' safety is seriously at risk or where there is risk of material financial loss to Board

68

NHS England may give notice in writing to the contractor terminating the contract with immediate effect or with effect from such date as may be specified in the notice if—

(a) the contractor has breached a term of the contract and, as a result of that breach, the safety of the contractor's patients would be at serious risk if the contract is not terminated; or

(b) NHS England considers that contractor's financial situation is such that NHS England would be at risk of material financial loss.

Termination by the Board for unlawful sub-contracting

69

(1) This paragraph applies if the contractor breaches the condition specified in paragraph 44(10) relating to the sub-contracting of clinical services under the contract and it comes to NHS England's attention that the contractor has done so.

(2) Where this paragraph applies NHS England must give notice in writing to the contractor—

(a) terminating the contract with immediate effect; or

(b) instructing the contractor to terminate with immediate effect the sub-contracting arrangements that give rise to the breach, and, if the contractor fails to comply with that instruction, NHS England must give notice in writing to the contractor terminating the contract with immediate effect.

Termination by the Board: remedial notices and breach notices

70

(1) Where a contractor's breach of the contract is not one to which any of paragraphs 65 to 69 apply and that breach is capable of remedy, NHS England must, before taking any action it is otherwise entitled to take by virtue of the contract, give notice in writing to the contractor requiring it to remedy the breach (a “remedial notice”).

(2) A remedial notice must specify—

(a) details of the breach;

(b) the steps that the contractor must take to the satisfaction of NHS England in order to remedy the breach; and

(3) The notice period must not be less than a period of 28 days beginning with the date on which the notice is given unless NHS England is satisfied that a shorter period is necessary to protect—

(a) the safety of the contractor's patients; or

(b) itself from material financial loss.

(4) Where NHS England is satisfied that the contractor has not taken the required steps to remedy the breach by the end of the notice period, NHS England may give a further notice in writing to the contractor terminating the contract with effect from such date as NHS England specifies in the notice.

(5) Where the contractor's breach of the contract is not one to which any of paragraphs 65 to 69 apply and the breach is not capable of remedy, NHS England may give notice in writing to the contractor requiring the contractor not to repeat the breach (a “breach notice”).

(6) If, following a breach notice or a remedial notice, the contractor—

(a) repeats the breach that was the subject of the breach notice or the remedial notice; or

(b) otherwise breaches the contract resulting in either a remedial notice or a further breach notice,

NHS England may give notice in writing to the contractor terminating the contract with effect from such date as NHS England specifies in the notice.

(7) NHS England may not exercise its right to terminate the contract under sub-paragraph (6) unless NHS England is satisfied that the cumulative effect of the breaches is such that to allow the contract to continue would prejudice the efficiency of the services to be provided under the contract.

(8) If the contractor is in breach of any obligation under the contract and a breach notice or a remedial notice in respect of the default giving rise to the breach has been given to the contractor, NHS England may withhold or deduct monies which would otherwise be payable under the contract in respect of the obligation which is the subject matter of the default.

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

71

(1) If NHS England becomes aware that a contractor which is a company limited by shares is carrying on any business which NHS England considers to be detrimental to the contractor's performance of its obligations under the contract—

(a) NHS England may give notice in writing to the contractor requiring it to cease carrying on that business before the end of a period of at least 28 days beginning with the date on which the notice is given (“the notice period”); and

(b) if the contractor has not satisfied NHS England that it has ceased carrying on that business by the end of the notice period, NHS England may give a further notice in writing to the contractor terminating the contract with immediate effect or from such date as may be specified in the notice.

(2) Where the contractor consists of two or more persons practising in partnership and one or more of those persons has or have left the partnership during the existence of the contract, NHS England may give notice in writing to the contractor terminating the contract on such date as may be specified in the notice if, in NHS England's reasonable opinion, the change in the membership of the partnership is likely to have a serious adverse impact on the ability of the contractor or NHS England to perform its obligations under the contract.

(3) A notice given to the contractor under sub-paragraph (2) must specify—

(a) the date on which the contract is to terminate; and

(b) NHS England's reasons for considering that the change in the membership of the partnership is likely to have a serious adverse impact on the ability of the contractor or NHS England to perform its obligations under the contract.

Contract sanctions

72

(1) In this paragraph and in paragraph 73, “contract sanction” means—

(a) termination of specified reciprocal obligations under the contract;

(b) suspension of specified reciprocal obligations under the contract for a period of up to six months; or

(2) Where NHS England is entitled to terminate the contract under paragraphs 66, 67, 68, 69 70(4) or (6) or 71, it may instead impose any of the contract sanctions if NHS England is reasonably satisfied that the contract sanction to be imposed is appropriate and proportionate to the circumstances giving rise to NHS England's entitlement to terminate the contract.

(3) NHS England may not, under sub-paragraph (2), impose any contract sanction that has the effect of terminating or suspending any obligation to provide, or any obligation that relates to, essential services.

(4) If NHS England decides to impose a contract sanction, NHS England must—

(a) give notice in writing to the contractor of the contract sanction that it proposes to impose and the date upon which that sanction is to be imposed; and

(b) include in the notice an explanation of the effect of the imposition of the sanction.

(5) Subject to paragraph 73 NHS England may not impose the contract sanction until the end of a period of at least 28 days beginning with the date on which NHS England gives notice to the contractor under sub-paragraph (4) unless NHS England is satisfied that it is necessary to do so in order to protect—

(a) the safety of the contractor's patients; or

(b) itself from material financial loss.

(6) Where NHS England imposes a contract sanction, NHS England may charge the contractor the reasonable costs of any additional administration that NHS England has incurred in order to impose, or as a result of imposing, the contract sanction.

Contract sanctions and the NHS dispute resolution procedure

73

(1) If there is a dispute between NHS England and the contractor in relation to a contract sanction that NHS England is proposing to impose, NHS England may not, subject to sub-paragraph (5), impose the contract sanction except in the circumstances specified in sub-paragraphs (2) and (3).

(2) The circumstances specified in this sub-paragraph are if the contractor—

(a) refers the dispute relating to the contract sanction to the NHS dispute resolution procedure before the end of a period of 28 days beginning with the date on which the contractor was given notice in accordance with paragraph 72(4) (or such longer period as may be agreed in writing with NHS England); and

(b) gives notice to NHS England in writing that it has done so.

(3) Where the circumstances specified in sub-paragraph (2) apply, NHS England may not impose the contract sanction unless—

(a) there has been a final determination of the dispute in accordance with regulation 83 (or by a court) and that determination permits NHS England to impose the contract sanction; or

(b) the contractor ceases to pursue the NHS dispute resolution procedure,

whichever is the sooner.

(4) If the contractor does not invoke the NHS dispute resolution procedure before the end of the period specified in sub-paragraph (2)(a), NHS England may impose the contract sanction with immediate effect.

(5) If NHS England is satisfied that it is necessary to impose the contract sanction before the NHS dispute resolution procedure is concluded in order to protect—

(a) the safety of the contractor's patients; or

(b) itself from material financial loss,

NHS England may impose the contract sanction with immediate effect, pending the outcome of that procedure (or any court proceedings).

Termination and the NHS dispute resolution procedure

74

(1) Where NHS England is entitled to give notice in writing to the contractor terminating the contract under paragraphs 66, 67, 68, 70(4) or (6) or 71, NHS England must, in the notice given to the contractor under those provisions, specify a date on which the contract terminates that is at least 28 days after the date on which NHS England gives notice to the contractor, unless sub-paragraph (2) applies.

(2) This sub-paragraph applies if NHS England is satisfied that a period of less than 28 days is necessary in order to protect—

(a) the safety of the contractor's patients; or

(b) itself from material financial loss.

(3) Where—

(a) sub-paragraph (1) applies, but the exceptions in sub-paragraph (2) do not apply; and

(b) the contractor invokes the NHS dispute resolution procedure before the end of the notice period referred to in sub-paragraph (1) and gives notice in writing to NHS England that it has done so,

the contract does not terminate at the end of the notice period but instead only terminates in the circumstances described in sub-paragraph (4).

(4) The circumstances described in this sub-paragraph for the termination of the contract are if and when—

(a) there has been a final determination of the dispute under the NHS dispute resolution procedure (or by a court) and that determination permits NHS England to terminate the contract; or

(b) the contractor ceases to pursue the NHS dispute resolution procedure,

whichever is the earlier.

(5) If NHS England is satisfied that it is necessary to terminate the contract before the NHS dispute resolution procedure is (or any court proceedings are) concluded in order to protect—

(a) the safety of the contractor's patients; or

(b) itself from material financial loss,

sub-paragraphs (3) and (4) do not apply and NHS England may confirm, by giving notice in writing to the contractor, that the contract will nevertheless terminate at the end of the period of the notice given under paragraphs 66, 67, 68, 70(4) or (6) or 71.

Consultation with the Local Medical Committee

75

(1) If NHS England is considering—

(a) terminating the contract under paragraphs 66, 67, 68, 70(4) or (6) or 71;

(b) whether a remedial notice or a breach notice under paragraph 70 should be given in writing to the contractor; or

NHS England must, if it is reasonably practicable to do so, consult the Local Medical Committee (if any) for the area in which the contractor is providing services under the contract before it terminates the contract or imposes a contract sanction.

(2) Whether or not the Local Medical Committee has been consulted under sub-paragraph (1), if NHS England imposes a contract sanction on a contractor or terminates a contract in accordance with this Part, it must, as soon as reasonably practicable, give notice in writing to the Local Medical Committee of the contract sanction imposed or of the termination of the contract (as the case may be).

SCHEDULE 4 — Consequential amendments

Amendment of the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc) Regulations 2004

1

In the National Health Service (General Medical Service Contracts) (Prescription of Drugs etc) Regulations 2004 , in Schedule 2 (drugs, medicines and other substances that may be ordered only in certain circumstances: interpretation)—

(a) for the definition of “general medical practitioner” substitute—

“general medical practitioner” has the meaning given in regulation 3 of the National Health Service (General Medical Services Contracts) Regulations 2015;

, and

(b) for the definition of “patient” substitute—

“patient” has the meaning given in regulation 3 of the National Health Service (General Medical Services Contracts) Regulations 2015;

Amendment of the Primary Medical Services (Sale of Goodwill and Restrictions on Sub-contracting) Regulations 2004

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