Legalize / United Kingdom / Statutory-Instrument

The National Health Service (Personal Medical Services Agreements) Regulations 2015

Type Statutory-Instrument

Publication 2015-11-06

Last updated 2026-07-10

State In force

Department Statute Law Database

Source legislation.gov.uk

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(4) Where the patient is the holder of an S1 Healthcare Certificate or S1 equivalent document, the contractor must send that certificate or document, or a copy of that certificate or document, to the the NHS Business Services Authority—

(a) electronically to nhsbsa.faregistrationsohs@nhs.net, or

(b) by post in hard copy form to Cost Recovery, Overseas Healthcare Service, Bridge House, 152 Pilgrim Street, Newcastle Upon Tyne, NE1 6SN.

Medicines and Healthcare products Regulatory Agency Central Alerting System

67G

A contractor must—

(a) provide to the Medicines and Healthcare products Regulatory Agency (“the MHRA”) on request, an electronic mail address which is registered to the contractor’s practice;

(b) monitor that address;

(c) if that address ceases to be registered to the practice, notify the MHRA immediately of its new electronic mail address; and

(d) provide to the MHRA on request, one or more mobile telephone numbers for use in the event the contractor is unable to receive electronic mail.

Collection of data relating to appointments in general practice

67H

(1) A contractor must participate in the collection of anonymised data relating to appointments for its registered patients (“GP practice data”) in accordance with the “GP Appointments Data Collection in Support of Winter Pressures” referred to in the Health and Social Care Information Centre (Establishment of Information Systems for NHS Services: General Practice Appointments Data Collection in Support of Winter Pressures) Directions 2017 (the functions of the Health and Social Care Information Centre under the Directions were transferred to NHS England by the Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023).

(2) The contractor must ensure that all GP practice data relating to the provision of primary medical services under its contract is recorded within the appointment book in accordance with the guidance.

(3) The contractor must ensure that the GP practice data is uploaded onto its computerised clinical systems and available for collection by NHS England at such intervals during each financial year as notified to the contractor by NHS England.

(4) For the purposes of this regulation, “appointment book” means a capability provided by the contractor’s computerised clinical systems and software supplier which supports the administration, scheduling, resourcing and reporting of appointments.

Collection of data relating to use of the online consultation tool and video consultations

67I

(1) The contractor must make available to NHS England such information as is specified by NHS England that is available to the contractor in connection with use of the online consultation tool under regulation 64ZD and video consultations under regulation 64ZF.

(2) The contractor must make information available to NHS England under paragraph (1) within such reasonable time frame as may be specified by NHS England.

Recording and reviewing patient safety events

67J

(1) The contractor must register for, and maintain an account with, the LFPSE Service that has administrator rights.

(2) In this regulation, “LFPSE Service” refers to the centralised system provided by NHS England to record information and provide data and analysis about events involving patient safety.

NHS staff surveys

67K

(1) The contractor must make available to NHS England such information as specified by NHS England in connection with staff surveys that relate to the contractor’s staff.

(2) The contractor must make information available to NHS England under paragraph (1) within such reasonable time frame as may be specified by NHS England.

Information relating to the Lung Cancer Screening Programme

67L

(1) A contractor must allow the extraction by NHS England, or by persons authorised by NHS England, of data reasonably required for the purpose of the Lung Cancer Screening Programme, from the record that the contractor is required to keep under regulation 60 by such means, and at such intervals, as are notified to the contractor by NHS England.

(2) The contractor must co-operate, in so far as is reasonable, with NHS England, or persons authorised by NHS England, in relation to data extractions under paragraph (1).

(3) In this regulation, “Lung Cancer Screening Programme” means the national programme arranged by NHS England of lung health checks for the purpose of detecting and diagnosing lung cancer, for persons identified by NHS England as recommended for such checks.

Inquiries about prescriptions and referrals

68

(1) The contractor must, subject to paragraphs (2) and (3), sufficiently answer any inquiries, whether oral or in writing, from NHS England concerning—

(a) any prescription form or repeatable prescription form issued or created by a prescriber;

(b) the considerations by reference to which prescribers issue such forms;

(d) the considerations by which the contractor makes such referrals or provides for them to be made on its behalf.

(2) An inquiry referred to in paragraph (1) may only be made for the purpose of obtaining information to assist NHS England to discharge its functions, or of assisting the contractor in the discharge of its obligations, under the agreement.

(3) The contractor is not obliged to answer any inquiry referred to in paragraph (1) unless it is made—

(a) in the case of paragraph (1)(a) or (b), by an appropriately qualified health care professional; or

(b) in the case of paragraph (1)(c) or (d), by an appropriately qualified medical practitioner.

(4) The appropriately qualified person referred to in paragraph (3)(a) or (b) must —

(a) be appointed by NHS England to assist it in the exercise of NHS England’s functions under this regulation; and

(b) produce on request, written evidence that they are authorised by NHS England to make such an inquiry on NHS England’s behalf.

Provision of information to a medical officer etc.

69

(1) The contractor must, if satisfied that the patient consents—

(a) supply in writing to any person specified in paragraph (3), (a “relevant person”), before the end of such reasonable period as that person may specify, such clinical information as any of the persons mentioned 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 purposes 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 contact 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

70

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

(2) NHS England may request a return relating to the agreement 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 such date as 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 agreement.

(5) NHS England must prepare a draft record of the review referred to in paragraph (2) for comment by the contractor and, having regard to such comments, must produce a final written record of the review.

(6) NHS England must send a copy of the final record of the review referred to in paragraph (5) to the contractor.

Practice leaflet

71

(1) A contractor which provides essential services must compile a document (a “practice leaflet”) which must include the information specified in Part 6 of Schedule 2.

(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 12 — Complaints

Complaints procedure

72

(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 agreement.

(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

73

(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 agreement 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 and Wales, 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 questions which are reasonably put to the contractor by NHS England;

(b) providing 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 13 — Dispute resolution

Local resolution of agreement disputes

74

(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 agreement 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 dealt with under the NHS dispute resolution procedure by virtue of paragraph 41(1) of Schedule 2 where it is not practicable for the parties to attempt local resolution before the expiry of the period seven days specified in paragraph 41(4) of that Schedule.

Dispute resolution: non-NHS contracts

75

(1) Where an agreement is not an NHS contract, a dispute arising out of or in connection with the agreement, except any matter dealt with under the complaints procedure under Part 12, may be referred for consideration and determination by 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 by 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 agree to be bound by any determination made by the adjudicator.

NHS dispute resolution procedure

76

(1) The procedure specified in this regulation and in regulation 77 applies to a dispute arising out of or in connection with the agreement which is referred to the Secretary of State in accordance with—

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

(b) regulation 75(1) (where the agreement 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 38 of Schedule 2 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 agreement; 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 an agreement 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 a person or persons to consider and determine the dispute.

(6) Before reaching a decision about who should determine the dispute, either under paragraph (5) or under 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 may wish to make about the matter under dispute before the end of a specified period.

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

(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) in each case, request in writing a party to whom a copy of the representations is given to make, within a specified period, any written observations which that party may wish 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 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

(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 77; and

Determination of dispute

77

(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 the adjudicator makes a direction as to payments under section 9(6) of the Act (as it has effect as a result of section 9 of the Act or regulation 77(1), that direction is to be enforceable in a county court (if the court so orders) as if it were a judgement or order of the court.

(3) Where a dispute is referred for determination in accordance with regulation 75(1)—

(a) section 9(12) and (13) of the Act apply in the same manner as those provisions apply to an agreement 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 agreement 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

78

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

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

PART 14 — Miscellaneous

Clinical governance

79

(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 agreement.

(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 safeguards high standards of care by creating an environment in which clinical excellence can flourish.

Friends and Family Test

80

(1) A contractor which provides essential services must give all patients who use the contractor's practice the opportunity to provide feedback about the service received from the contractor's 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 which provides essential services 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 NHS England

81

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

82

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); and

(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 workers etc.).

Insurance

83

(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 agreement 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 agreement, 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 it is held by a person employed or engaged by the contractor in connection with clinical services which that person provides under the agreement or, as the case may be, sub-contract.

Public liability insurance

84

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 agreement which are not covered by the indemnity agreement referred to in regulation 83.

Gifts

85

(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 agreement; 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 agreement is with a qualifying body—

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

(ii) a director or secretary of the qualifying body;

(d) any general medical practitioner engaged by the contractor for the purposes of the agreement;

(e) 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 (d); or

(f) any person whose relationship with a contractor (where the contractor is an individual medical practitioner) or with a person specified in sub-paragraphs (b) to (d) 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 (f).

(5) The register referred to in 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

86

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

87

The agreement 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

88

(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 an agreement 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 an agreement 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 an agreement 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 by Schedule 4, 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) “agreement” includes any agreement 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

89

Schedule 3 makes provision in respect of the amendment to secondary legislation which are consequential upon the coming into force of these Regulations.

Revocations

90

Schedule 4 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 — NHS England’sNHS England’sList 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.

3

To secure registration of still-birth

4

To enable payment to be made from 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 of the amount of Council Tax payable

SCHEDULE 2 — Other required terms

PART 1 — Provision of services

Services to registered patients

1

Where the agreement provides for a contractor to provide essential services, the contractor must—

(a) provide those services, and such other services that the contractor is required to provide to its patients, at such times, within core hours, as are appropriate to meet the reasonable needs of those patients; and

(b) have in place arrangements for the contractor's patients to access such services throughout the core hours in case of emergency.

Premises

2

(1) The contractor must ensure that the premises used for the provision of services under the agreement 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 agreement which sets out steps to be taken by the contractor to bring the premises up to the required standard.

Telephone services

3

(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 agreement; or

(b) any other person to contact the contractor's practice in relation to services provided at the contractor's practice 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.

New telephone contract or arrangement

3A

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

Cost of relevant calls

4

(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 at the contactor's practice under the agreement; andcalls made by persons, other than patients, to the contractor's practice in relation to services provided at the contractor's practice as part of the health service.

Attendance at practice premises

5

(1) The contractor must take steps to ensure that all of the following means of contacting the practice 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 64ZE(3);

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

(2) Subject to sub-paragraph (2A), 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.

(2A) The contractor must not ask a patient to contact the practice on another day.

(3) For matters which the contractor has identified as clinically urgent, 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.

(3A) For matters which the contractor has identified as not clinically urgent, the appropriate response must be provided before the end of the next working day after contact.

(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

6

(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 a 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.

Clinical reports

7

(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—

(a) to the person with whom the patient is registered for the provision of essential services (or their equivalent); or

(b) if the person referred to in paragraph (a) is not known to NHS England, or to the Local Health Board, Health Board or Health and Social Services Board, in whose area the patient is resident.

(3) This paragraph does not apply in relation to the provision of out of hours services by a contractor which is, by virtue of regulation 22, required to comply with the quality standards or requirements referred to in that regulation.

Storage of vaccines

8

The contractor must ensure that all—

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

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

Infection control

9

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

Duty of co-operation

10

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

(a) a particular 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

(b) out of hours services, either at all or in respect of some periods or some services,

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 in so far 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 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 agreement does not include the provision of out of hours services to make itself available during the out of hours period.

Duty of co-operation: Primary Care Networks

10A

(1) A contractor must comply with the requirements in sub-paragraph (2) where it is—

(a) signed up to the Network Contract Directed Enhanced Scheme (“the Scheme”); or

(b) not signed up to the Scheme but its registered patients or temporary residents, are provided with services under the Scheme (“the services”) by a contractor which is a member of a primary care network.

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

(a) co-operate, in so far as is reasonable, with any person responsible for the provision of the 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 the services;

(d) participate in primary care network meetings, in so far as is reasonable;

(e) take reasonable steps to provide information to its registered patients about the services, including information on how to access the services and any changes to them; and

(f) ensure that it has in place suitable arrangements to enable the sharing of data to support the delivery of the services, business administration and analysis activities.

(3) For the purposes of this paragraph, “primary care network” means a network of contractors and other providers of services which has been approved by NHS England, serving an identified geographical area ...

Duty to have regard to Armed Forces Covenant principles

10B

When providing services under the agreement, the contractor must have due regard to the principles contained in section 343AA(1)(a) to (c) of the Armed Forces Act 2006 in relation to its patients and prospective patients.

Cessation of service provision: information requests

11

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

(a) a particular service; or

(b) out of hours services, either at all or in respect of some periods or some services,

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 an agreement for the provision of such services.

Co-operation with NHS England: performance management

11A

The contractor must co-operate with NHS England, in so far as is reasonable, in relation to the performance and improvement of services provided under the agreement, including co-operating with the provision of any support, performance review or improvement activity.

PART 2 — Patients: general

General provision

12

This Part only applies to a contractor which provides essential services.

List of patients

13

(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 17, 18, 18A, 31D or 31F and who have not been subsequently removed from that list under paragraphs 22 to 30; and

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

(i) paragraph 38(1)(a), or

(ii) paragraph 38(1)(b) (by virtue of a determination of the assessment panel under paragraph 40(8) which has not subsequently been overturned by a determination of the Secretary of State under paragraph 41 or by a court).

(2) The contractor must, upon receipt of a reasonable written request by 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.

Newly registered patients – alcohol dependency screening

14

(1) Where a patient has been—

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

(b) assigned to that list by NHS England,

the contractor must 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 health risks to that patient.

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

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

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

(3) Where, under sub-paragraph (2), the contractor identifies a patient as positive using either of the shortened versions of the AUDIT questionnaire specified in sub-paragraph (2), the remaining questions of the full ten question AUDIT questionnaire must 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 any 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 or depression; and

(c) where anxiety or depression is diagnosed, provided with any treatment and support which may be required under the agreement, including a 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 60.

Patients living with frailty

14A

(1) A contractor must take steps each year to identify any registered patient aged 65 years and over who is living with moderate to severe frailty.

(2) The contractor must comply with the requirement in sub-paragraph (1) by using the Electronic Frailty Index or any other appropriate assessment tool.

(3) Where the contractor identifies a patient aged 65 years or over who is living with severe frailty, the contractor must—

(a) undertake a clinical review in respect of the patient which includes—

(i) an annual review of the patient’s medication, and

(ii) where appropriate, a discussion with the patient about whether the patient has fallen in the last 12 months;

(b) provide the patient with any other clinically appropriate interventions; and

(c) where the patient does not have an enriched Summary Care Record, advise the patient about the benefits of having an enriched Summary Care Record and activate that record at the patient’s request.

(4) A contractor must, using codes agreed by NHS England for this purpose, record in the patient’s Summary Care Record any appropriate information relating to clinical interventions provided to a patient under this paragraph.

Accountable GP

15

(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 agreement 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 was 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 them 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 60.

(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 aged 75 years and over: accountable GP

16

(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 agreement 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 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 is so accepted; or

(b) in the case of a person who is included in the contractor's list of patients immediately before the date on which these Regulations come into force and 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 contractor in the course of which the contractor must make such inquiries and undertake such examinations of the patient as appear to it to be appropriate in all the circumstances.

NHS e-Referral Service (e-RS)

16A

(1) Except in the case of a contractor to which sub-paragraph (2) or (3) applies, a contractor must require the use in its practice ... of the system for electronic referrals known as the NHS e-Referral Service (“e-RS”) in respect of each referral of any of its registered patients to a first consultant-led out-patient appointment for medical services under the Act in respect of which the facility to use e-RS is available.

(2) This sub-paragraph applies to a contractor which does not yet have e-RS in place for use in the contractor’s practice ....

(3) This sub-paragraph applies to a contractor which—

(a) is experiencing technical or other practical difficulties which are preventing the use, or effective use, of e-RS in its practice ...; and

(b) has notified NHS England that this is the case.

(4) A contractor to which sub-paragraph (2) applies must require the use in its practice ... of alternative means of referring its registered patients to a first consultant-led out-patient appointment for medical services under the Act until such time as the contractor has e-RS in place for use in its practice ....

(5) A contractor to which sub-paragraph (3) applies—

(a) must ensure that a plan is agreed between the contractor’s practice and NHS England for resolving the technical or other practical difficulties which are preventing the use, or effective use, of e-RS in the contractor’s practice ...; and

(b) must require the use in its practice ... of alternative means of referring its registered patients to a first consultant-led out-patient appointment for medical services under the Act until such time as those technical or other practical difficulties have been resolved to the satisfaction of NHS England.

Direct booking by NHS 111 or via a connected service

16B

(1) A contractor must ensure that as a minimum the following number of appointments during core hours for its registered patients are made available per day for direct booking by or via a service (“a connected service”) approved by NHS England that is or may be accessed via NHS 111—

(a) one, where a contractor has 3,000 registered patients or fewer; or

(b) one for each whole 3,000 registered patients, where a contractor has more than 3,000 registered patients.

(2) The requirements in sub-paragraphs (1) and (3) do not apply where—

(a) NHS England and the contractor have agreed to suspend the requirements for operational reasons; or

(b) the contractor does not have access to computer systems and software which would enable it to offer the service described in sub-paragraph (1).

(3) A contractor must—

(a) configure its computerised systems to allow direct booking by NHS 111 or via a connected service;

(b) monitor its booking system for appointments booked by NHS 111 or via a connected service;

(c) assess the Post Event Message received from NHS 111 or via a connected service in order to decide whether an alternative to the booked appointment should be arranged, such as a telephone call to the patient or an appointment with another healthcare professional and where appropriate, make those arrangements; and

(d) co-operate with NHS England in its oversight of direct booking by NHS 111 or via a connected service by providing any information relating to direct booking by NHS 111 or via a connected service which is reasonably required by NHS England.

(4) In this paragraph, “Post Event Message” means the electronic message which is sent to a contractor at the end of a telephone call to NHS 111 or to a connected service.

(5) In order to assist in the management of a serious or potentially serious risk to human health arising as a consequence of a disease being, or in anticipation of a disease being imminently—

(a) pandemic; and

(b) a serious risk or potentially a serious risk to human health,

NHS England may with the agreement of the Secretary of State make an announcement to the effect that the minimum numbers of appointments mentioned in paragraph (1) are modified in the circumstances specified (which may limit the area to which the modification relates), and for the duration of the period specified, in the announcement, and where NHS England does so, the minimum numbers are as so modified.

Referral pathways

16C

(1) NHS England may notify the contractor of referral pathways that apply to the referral of patients for other services under the Act.

(2) The contractor must, where clinically appropriate, comply with any relevant referral pathways notified under paragraph (1), prior to referring a patient for services under the Act.

(3) In this paragraph—

“Advice and Guidance” means arrangements established by NHS England to enable contractors to obtain consultant-led clinical advice about the management of a patient for the purpose of informing clinical decision making in relation to a referral;

“referral pathways” means arrangements, such as Advice and Guidance, determined by NHS England as applying to the referral of a patient for a service under the Act, including any locally determined arrangements that apply in relation to the contractor’s practice area.

Directory of Services

16D

(1) The contractor must record in the Directory of Services an electronic mail address nominated for the purpose of communicating clinical information relating to the contractor's patients with health service providers.

(2) The contractor must monitor the electronic mail address nominated under paragraph (1) at least once per day during core hours.

(3) In paragraph (1), “Directory of Services” means the national directory of services provided as part of the health service in England, managed by NHS England.

Application for inclusion in a list of patients

17

(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 (“the applicant”) 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 from 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 the 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 Mental Capacity Act 2005 .

(4A) Where the contractor receives an application by the method referred to in sub-paragraph (3)(a), they must submit the information provided in the application via the online registration service referred to in sub-paragraph (3)(b), except where the contractor’s computerised clinical system does not facilitate interconnectivity with the online registration service supplied by NHS England.

(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, to the person making the application on the applicant's behalf) of that acceptance.

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

Inclusion in list of patients: armed forces personnel

18

(1) The contractor may, if the contractor's list of patients is open, include a person to whom sub-paragraph (2) applies in its list of patients for a period of up to two years and paragraph 28(1)(b) does not apply in respect of any person included in the contractor's 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 Services 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 comes to an end, the contractor must—

(a) notify Defence Medical Services in writing that its responsibility for that person 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.

Inclusion in list of patients: detained persons

18A

(1) A contractor must, if the contractor’s list of patients is open, include a person to whom sub-paragraph (2) applies (a “detained person”) in that list and paragraph 28(1)(b) does not apply in respect of a detained 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—

(a) 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;

(b) is not registered as a patient with a provider of primary medical services; and

(c) makes an application under this paragraph in accordance with sub-paragraph (3) to be included in the contractor’s list of patients by virtue of sub-paragraph (1) or (6) before the scheduled release date.

(3) An application under sub-paragraph (2)(c) may be made during the period commencing one month prior to the scheduled release date and ending 24 hours prior to that date.

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