The National Health Service (General Medical Services Contracts) (Wales) Regulations 2023

• (13) In this paragraph, “specified period” means such period as the Welsh Ministers specify in the request, being not less than 2, nor more than 4, weeks beginning with the date on which the notice referred to is given, but the Welsh Ministers may, if they consider that there is good reason for doing so, extend any such period (even after it has expired) and, where they do so, a reference in this paragraph to the specified period is to the period as so extended.

• (14) Subject to the other provisions of this paragraph and paragraph 107 and to any agreement by the parties, the adjudicator has wide discretion in determining the procedure of the dispute resolution to ensure the just, expeditious, economical and final determination of the dispute.

Determination of the dispute

107

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

• (2) Where a dispute in relation to a contract is referred for determination in accordance with paragraph 105(1)—

• (a) section 7(12) and (13) of the Act apply in the same manner as those subsections apply to a dispute referred for determination in accordance with section 7(6) or (7) of the Act, and

• (b) section 48(5) of the Act applies to any dispute referred for determination in relation to a contract which is not an NHS contract as if it were referred for determination in accordance with section 7(6) of the Act.

Interpretation of this Part

108

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

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

PART 11 — Variation and termination of contracts

Variation of a contract: general

109

• (1) Subject to sub-paragraph (2) and paragraphs 76(8), 110, 111 and 124 of this Schedule no amendment or variation has effect unless it is in writing and signed by or on behalf of the Local Health Board and the contractor.

• (2) In addition to the specific provision made in paragraphs 110(6), 111(11), and 124 the Local Health Board may vary the contract without the contractor’s consent where it—

• (a) is reasonably satisfied that it is necessary to vary the contract so as to comply with the Act, any regulations made pursuant to that Act, or any direction given by the Welsh Ministers pursuant to that Act, and

• (b) notifies the contractor in writing of the wording of the proposed variation and the date upon which that variation is to take effect, and

where it is reasonably practicable to do so, the date that the proposed variation is to take effect must not be less than 14 days after the date on which the notice under paragraph (b) is served on the contractor.

Variation provisions specific to a contract with an individual medical practitioner

110

• (1) If a contractor which is an individual medical practitioner proposes to practise in partnership with one or more persons during the existence of the contract, the contractor must notify the Local Health Board in writing of—

• (a) the name of the person or persons with whom it proposes to practise in partnership, and

• (b) the date on which the contractor wishes to change its status as a contractor from that of an individual medical practitioner to that of a partnership which must not be less than 28 days after the date upon which it has served the notice on the Local Health Board pursuant to this sub-paragraph.

• (2) A notice under sub-paragraph (1) must in respect of the person or each of the persons with whom the contractor is proposing to practise in partnership, and also in respect of itself as regards the matters specified in paragraph (c)—

• (a) confirm that the person is either—

• (i) a medical practitioner, or

• (ii) a person who satisfies the conditions specified in section 44(2)(b)(i) to (iv) of the Act,

• (b) confirm that the person satisfies the conditions imposed by regulations 5 and 6,

• (c) 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, and

the notice must be signed by the individual medical practitioner and by the person, or each of the persons (as the case may be), with whom the medical practitioner is proposing to practise in partnership.

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

• (4) If the Local Health Board is satisfied as to the accuracy of the matters specified in sub-paragraph (2) that are included in the notice, the Local Health Board must give notice in writing to the contractor confirming that the contract continues with the partnership entered into by the contractor and its partners, from a date that the Local Health Board specifies in that notice.

• (5) Where it is reasonably practicable, the date specified by the Local Health Board pursuant to sub-paragraph (4) is the date requested in the notice served by the contractor pursuant to sub-paragraph (1), or, where that date is not reasonably practicable, the date specified is to be a date after the requested date that is as close to the requested date as is reasonably practicable.

• (6) Where a contractor has given notice to the Local Health Board pursuant to sub-paragraph (1), the Local Health Board—

• (a) may vary the contract but only to the extent that it is satisfied it is necessary to reflect the change in status of the contractor from an individual medical practitioner to a partnership, and

• (b) if it does propose to so vary the contract, it must include in the notice served on the contractor pursuant to sub-paragraph (4) 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 individuals practising in partnership

111

• (1) Subject to sub-paragraph (4), where a contractor consists of two or more individuals practising in partnership , in the event that the partnership is terminated or dissolved, the contract continues with that partnership unless the contract is terminated by the contractor or Local Health Board under the provisions of this Part and the contract may only continue with just one of the former partners if that partner is—

• (a) nominated in accordance with sub-paragraph (3), and

• (b) a medical practitioner who meets the condition in regulation 5(1)(a),

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

• (2) A contractor must notify the Local Health Board in writing at least 28 days in advance of the date on which the contractor proposes to change its status from that of a partnership to that of an individual medical practitioner pursuant to sub-paragraph (1).

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

• (a) specify the date on which the contractor proposes to change its status from that of a partnership to that of an individual medical practitioner,

• (b) specify the name of the medical practitioner with whom the contract is to continue, which must be one of the partners, and

• (c) be signed by all of the persons who are practising in partnership.

• (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 the Local Health Board 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, the Local Health Board—

• (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 the Local Health Board 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 the Local Health Board reaches an agreement, the Local Health Board must give notice in writing to the remaining partner in the partnership confirming—

• (a) the terms upon which the Local Health Board agrees to the contract continuing with that partner including the period, as specified by the Local Health Board, during which the contract is to continue (“the interim period”) and such a period must not exceed 6 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 the Local Health Board 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,

the Local Health Board 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, the Local Health Board must give notice in writing to the contractor terminating the contract with immediate effect.

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

• (12) If the Local Health Board varies the contract under sub-paragraph (11), the Local Health Board 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(1).

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

Termination by agreement

112

The Local Health Board 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 should be terminated.

Termination on the death of an individual medical practitioner

113

• (1) Where the contractor is an individual medical practitioner and the contractor dies, the contract terminates at the end of the period of 7 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) the Local Health Board 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 7 days, and

• (b) the contractor’s personal representatives confirm in writing to the Local Health Board 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 the Local Health Board—

• (i) the Local Health Board agrees to provide reasonable support which would enable clinical services under the contract to continue;

• (ii) the Local Health Board and the contractor’s personal representatives agree the terms on which the provision of clinical services can continue; and

• (iii) the Local Health Board 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 7 days referred to in sub-paragraph (1).

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

Termination by the contractor

114

• (1) A contractor may terminate the contract by serving notice in writing on the Local Health Board at any time.

• (2) Where a contractor serves notice pursuant to sub-paragraph (1), the contract must, subject to sub-paragraph (3), terminate 6 months after the date on which the notice is served (“the termination date”), save that if the termination date is not the last calendar day of a month, the contract must instead terminate on the last calendar day of the month in which the termination date falls.

• (3) Where the contractor is an individual medical practitioner and sub-paragraph (2) applies to the contractor, the Local Health Board has discretion to agree an earlier termination date if exceptional circumstances exist which make it reasonable for the termination date to be brought forward. If the termination date is to be brought forward, this date is to be agreed by the Local Health Board and the contractor.

• (4) This paragraph is without prejudice to any other rights to terminate the contract that the Local Health Board or contractor may have.

Late payment notices

115

• (1) The contractor may give notice in writing (a “late payment notice”) to the Local Health Board if the Local Health Board has failed to make any payments due to the contractor in accordance with any term of the contract regarding prompt payment which has the effect specified in regulation 20(1) and the contractor must specify in the late payment notice the payments that the Local Health Board has failed to make in accordance with that regulation.

• (2) Subject to sub-paragraph (3), the contractor may, at least 28 days after having served a late payment notice, terminate the contract by a further written notice if the Local Health Board has still failed to make the payments due to the contractor, and that were specified in the late payment notice served on the Local Health Board pursuant to sub-paragraph (1).

• (3) If, following receipt of a late payment notice, the Local Health Board refers the matter to the NHS dispute resolution procedure within 28 days of the date upon which it is served with the late payment notice, and it notifies the contractor in writing that it has done so within that period of time, the contractor may not terminate the contract pursuant to sub-paragraph (2) until—

• (a) there has been a determination of the dispute pursuant to paragraph 106 and that determination permits the contractor to terminate the contract, or

• (b) the Local Health Board ceases to pursue the NHS dispute resolution procedure,

whichever is the sooner.

• (4) This paragraph is without prejudice to any other rights to terminate the contract that the contractor may have.

Termination by the Local Health Board: general

116

The Local Health Board may only terminate the contract in accordance with—

• (a) the provisions in this Part, or

• (b) such other termination provisions as the contractor and Local Health Board include in the contract.

Termination by the Local Health Board for breach of conditions in regulation 5

117

• (1) Subject to sub-paragraph (2), the Local Health Board must serve notice in writing on 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) as a result of a suspension specified in sub-paragraph (6), sub-paragraph (1) does not apply unless—

• (a) the contractor is unable to satisfy the Local Health Board 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) the Local Health Board is satisfied that the circumstances of the suspension are such that if the contract is not terminated forthwith—

• (i) the safety of the contractor’s patients is at serious risk, or

• (ii) the Local Health Board is at risk of material financial loss.

• (3) Except in a case to which paragraph 111(4) applies, where the contractor is—

• (a) two or more persons practising in partnership, and the condition specified in regulation 5(1)(b) is no longer satisfied, or

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

sub-paragraph (4) applies.

• (4) Where sub-paragraph (3)(a) or (b) applies, the Local Health Board must, subject to sub-paragraph (8)—

• (a) serve notice in writing on the contractor terminating the contract forthwith, or

• (b) serve notice in writing on the contractor confirming that the Local Health Board is to allow the contract to continue, for a period specified by the Local Health Board in accordance with sub-paragraph (5) (the “interim period”), during which time the Local Health Board must, with the consent of the contractor, employ or supply one or more general medical practitioners to the contractor for the interim period to assist the contractor in the provision of clinical services under the contract.

• (5) The period specified by the Local Health Board under sub-paragraph (4)(b) must not exceed—

• (a) 6 months, or

• (b) in a case where the failure of the contractor to continue to satisfy the condition in regulation 5(1)(b) or, as the case may be, 5(1)(c), is the result of a suspension referred to in sub-paragraph (6), the period for which that suspension continues.

• (6) The suspensions referred to in sub-paragraphs (2) and (5)(b) are suspension—

• (a) by a Medical Practitioners Tribunal under—

• (i) section 35D (functions of a Medical Practitioners Tribunal) of the Medical Act 1983 in a health case, other than an indefinite suspension under section 35D(6), or

• (ii) section 38(1) (power to order immediate suspension etc. after a finding of impairment of fitness to practise) of that Act, or

• (b) by a Medical Practitioners Tribunal or an Interim Orders Tribunal under section 41A (interim orders) of that Act.

• (7) In sub-paragraph (6), “health case” has the meaning given in section 35E(4) of the Medical Act 1983.

• (8) Before deciding which of the options in sub-paragraph (4) to pursue, the Local Health Board must, whenever it is reasonably practicable to do so, consult the Local Medical Committee (if any) for its area.

• (9) If the contractor does not, pursuant to sub-paragraph (4)(b), consent to the Local Health Board employing or supplying a general medical practitioner during the interim period, the Local Health Board must serve notice in writing on the contractor terminating the contract with immediate effect.

• (10) If, at the end of the interim period, the contractor still falls within sub-paragraph (3)(a) or (b), the Local Health Board must serve notice in writing on the contractor terminating the contract with immediate effect.

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

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

118

The Local Health Board may serve notice in writing on the contractor terminating the contract with immediate effect, or from such date as may be specified in the notice if, after the contract has been entered into, it comes to the attention of the Local Health Board that written information provided to the Local Health Board by the contractor—

• (a) before the contract was entered into, or

• (b) pursuant to paragraph 96(1)(a) or 97(1)(b),

in relation 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 Local Health Board

119

• (1) The Local Health Board 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 regulations 5 and 6 was given under paragraph 96(1)(a) or 91(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

• (c) where the contract is with a company limited by shares to—

• (i) the company,

• (ii) any person legally or 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 44(2) or (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 (4), 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 (5), the contractor has been dismissed (otherwise than by reason of redundancy) from employment by a health service body unless, before the Local Health Board 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 107(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 6 months;

• (h) subject to sub-paragraph (6), 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 26 August 2002, and

• (ii) the contractor was sentenced to a term of imprisonment of longer than 6 months;

• (i) the contractor has been convicted of an offence, referred to in Schedule 1 to the Children and Young Persons Act 1933⁶² (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 1995⁶³ (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 2006⁶⁴, or

• (ii) any barred list within the meaning of the Safeguarding Vulnerable Groups (Northern Ireland) Order 2007⁶⁵ (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 5 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 5 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 2005⁶⁶ (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 1986⁶⁷ (bankruptcy restrictions order and undertaking), or Schedule 2A to the Insolvency (Northern Ireland) Order 1989⁶⁸ (bankruptcy restrictions order and undertaking) or Part 13 of the Bankruptcy (Scotland) Act 2016⁶⁹ (bankruptcy restrictions orders and interim bankruptcy restrictions orders), 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 7A of the Insolvency Act 1986 (debt relief orders) ..., 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 4 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) the partnership is dissolved by one of the partners, or a dissolution of the partnership is ordered by any competent court, tribunal or arbitrator, or

• (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;

• (u) the contractor is subject to—

• (i) a disqualification order under section 1 of the Company Directors Disqualification Act 1986⁷⁰ (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: general) or article 4 (disqualification undertakings: general) of the Company Directors Disqualification (Northern Ireland) Order 2002⁷¹, 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 the Local Health Board for the contractor to be medically examined because the Local Health Board is concerned that the contractor is incapable of adequately providing services under the contract; and, where the contract is with—

• (i) a partnership, and any partner has refused to comply with such a request, or

• (ii) a company limited by shares, and any person legally or beneficially owning a share in the company or any director or secretary of the company has refused to comply with such a request, and

the Local Health Board is not satisfied that the contractor is taking adequate steps to deal with the matter.

• (w) the contractor or its employees or agents (or anyone acting on its or their behalf) commits any prohibited act in relation to the contract with or without the knowledge of the Local Health Board.

• (4) The Local Health Board must not terminate the contract under sub-paragraph (3)(c) where the Local Health Board 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

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

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

• (ii) a director or secretary of the company,

as the case may be.

• (5) The Local Health Board may not terminate the contract under sub-paragraph (3)(d)—

• (a) until a period of at least 12 weeks 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 the Local Health Board 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) The Local Health Board must not terminate the contract under sub-paragraph (3)(h) where the Local Health Board 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

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

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

• (ii) a director or secretary of the company,

as the case may be.

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

120

The Local Health Board may serve notice in writing on the contractor terminating the contract forthwith or with effect from such date as may be specified in the notice if—

• (a) the contractor has breached the contract and as a result of that breach, the safety of the contractor’s patients is at serious risk if the contract is not terminated, or

• (b) the contractor’s financial situation is such that the Local Health Board considers that the Local Health Board is at risk of material financial loss.

Termination by the Local Health Board for unlawful sub-contracting

121

If the contractor breaches the condition specified in paragraph 76(11) and it comes to the Local Health Board’s attention that the contractor has done so, the Local Health Board must serve a notice in writing on the contractor—

• (a) terminating the contract with immediate effect, or

• (b) instructing the contractor to terminate the sub-contracting arrangements that give rise to the breach with immediate effect, and if it fails to comply with the instruction, the Local Health Board must serve a notice in writing on the contractor terminating the contract forthwith.

Termination by the Local Health Board: remedial notices and breach notices

122

• (1) Where a contractor has breached the contract other than as specified in paragraphs 117 to 121 and the breach is capable of remedy, the Local Health Board must, before taking any action it is otherwise entitled to take by virtue of the contract, serve a notice on the contractor requiring it to remedy the breach (“remedial notice”).

• (2) A remedial notice must specify—

• (a) details of the breach,

• (b) the steps the contractor must take to the satisfaction of the Local Health Board in order to remedy the breach, and

• (c) the period during which the steps must be taken (“the notice period”).

• (3) The notice period must, unless the Local Health Board is satisfied that a shorter period is necessary to—

• (a) protect the safety of the contractor’s patients, or

• (b) protect itself from material financial loss,

be no less than 28 days from the date that notice is given.

• (4) Where a Local Health Board is satisfied that the contractor has not taken the required steps to remedy the breach by the end of the notice period, the Local Health Board may terminate the contract with effect from such date as the Local Health Board may specify in a further notice to the contractor.

• (5) Where a contractor has breached the contract other than as specified in paragraphs 117 to 121 and the breach is not capable of remedy, the Local Health Board may serve notice on the contractor requiring the contractor not to repeat the breach (“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,

the Local Health Board may serve notice on the contractor terminating the contract with effect from such date as may be specified in that notice.

• (7) The Local Health Board must not exercise its right to terminate the contract under sub-paragraph (6) unless it is satisfied that the cumulative effect of the breaches is such that the Local Health Board considers that to allow the contract to continue would be prejudicial to the efficiency of the services to be provided under the contract.

• (8) If the contractor is in breach of any obligation and a breach notice or a remedial notice in respect of that default has been given to the contractor, the Local Health Board may withhold or deduct monies which would otherwise be payable under the contract in respect of that obligation which is the subject of the default.

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

123

• (1) Where the contractor is a company limited by shares, if the Local Health Board becomes aware that the contractor is carrying on any business which the Local Health Board considers to be detrimental to the contractor’s performance of its obligations under the contract—

• (a) the Local Health Board is entitled to give notice to the contractor requiring that it ceases carrying on that business before the end of a period of not less than 28 days beginning on the day on which the notice is given (“the notice period”), and

• (b) if the contractor has not satisfied the Local Health Board that it has ceased carrying on that business by the end of the notice period, the Local Health Board may, by a further written notice, terminate the contract forthwith or from such date as may be specified in the notice.

• (2) Where the contractor is two or more persons practising in partnership, the Local Health Board is entitled to terminate the contract by notice in writing on such date as may be specified in that notice where one or more partners have left the practice during the existence of the contract if in its reasonable opinion, the Local Health Board considers that the change in membership of the partnership is likely to have a serious adverse impact on the ability of the contractor or the Local Health Board to perform its obligations under the contract.

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

• (a) the date upon which the contract is to be terminated, and

• (b) the Local Health Board’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 the Local Health Board to perform its obligations under the contract.

Contract sanctions

124

• (1) In this paragraph and paragraph 125, “contract sanction” means—

• (a) termination or suspension of specified reciprocal obligations under the contract; and/or

• (b) withholding or deducting monies otherwise payable under the contract.

• (2) Subject to sub-paragraph (4), where the Local Health Board is entitled to terminate the contract under paragraphs 118, 119, 120, 122(4) or 122(6) or 123, it may instead impose any of the contract sanctions if the Local Health Board is reasonably satisfied that the contract sanction to be imposed is appropriate and proportionate to the circumstances giving rise to the Local Health Board’s entitlement to terminate the contract.

• (3) If the Local Health Board decides to impose a contract sanction, it must notify the contractor in writing of the contract sanction that it proposes to impose, the date upon which that sanction is to be imposed and provide in that notice an explanation of the effect of the imposition of that sanction.

• (4) Subject to paragraph 125, the Local Health Board must not impose the contract sanction until at least 28 days have elapsed, beginning with the date on which it served notice on the contractor pursuant to sub-paragraph (5) unless the Local Health Board is satisfied that it is necessary to do so in order to—

• (a) protect the safety of the contractor’s patients,

• (b) ensure continuity of care for the contractor’s patients, or

• (c) protect itself from material financial loss.

• (5) Where the Local Health Board imposes a contract sanction, the contractor must provide all information and assistance to the Local Health Board, throughout the period that the contract sanction applies, as the Local Health Board may reasonably require.

• (6) Where the Local Health Board imposes a contract sanction, the Local Health Board is entitled to charge the contractor the reasonable costs that the Local Health Board has incurred in order to impose, or as a result of imposing, the contract sanction.

Contract sanctions and the NHS dispute resolution procedure

125

• (1) If there is a dispute between the Local Health Board and the contractor in relation to a contract sanction that the Local Health Board is proposing to impose, the Local Health Board must not, subject to sub-paragraph (4), impose the proposed contract sanction except in the circumstances specified in sub-paragraph (2)(a) or (b).

• (2) If the contractor refers the dispute relating to the contract sanction to the NHS dispute resolution procedure within 28 days beginning with the date on which the Local Health Board served notice on the contractor in accordance with paragraph 124(3) (or such longer period as may be agreed in writing with the Local Health Board), and notifies the Local Health Board in writing that it has done so, the Local Health Board must not impose the contract sanction unless—

• (a) there has been a determination of the dispute pursuant to paragraph 106 and that determination permits the Local Health Board to impose the contract sanction, or

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

whichever is the sooner.

• (3) If the contractor does not invoke the NHS dispute resolution procedure within the time specified in sub-paragraph (2), the Local Health Board is entitled to impose the contract sanction with immediate effect.

• (4) If the Local Health Board is satisfied that it is necessary to impose the contract sanction before the NHS dispute resolution procedure is concluded in order to—

• (a) protect the safety of the contractor’s patients, or

• (b) protect itself from material financial loss,

the Local Health Board is entitled to impose the contract sanction forthwith, pending the outcome of that procedure.

Termination and the NHS dispute resolution procedure

126

• (1) Where the Local Health Board is entitled to serve written notice on the contractor terminating the contract pursuant to paragraph 118, 119, 120, 122(4) or 122(6) or 123(2), the Local Health Board must, in the notice served on the contractor pursuant to those provisions, specify a date on which the contract terminates that is not less than 28 days after the date on which the Local Health Board has served that notice on the contractor unless sub-paragraph (2) applies.

• (2) This sub-paragraph applies if the Local Health Board is satisfied that a period less than 28 days is necessary in order to—

• (a) protect the safety of the contractor’s patients, or

• (b) protect itself from material financial loss.

• (3) In a case falling within sub-paragraph (1) where the exception in sub-paragraph (2) does not apply, where the contractor invokes the NHS dispute resolution procedure before the end of the period of notice referred to in sub-paragraph (1), and it notifies the Local Health Board in writing that it has done so, the contract does not terminate at the end of the notice period but instead only terminates in the circumstances specified in sub-paragraph (4).

• (4) The contract only terminates if and when—

• (a) there has been a determination of the dispute pursuant to paragraph 106 and that determination permits the Local Health Board to terminate the contract, or

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

whichever is the sooner.

• (5) If the Local Health Board is satisfied that it is necessary to terminate the contract before the NHS dispute resolution procedure is concluded in order to—

• (a) protect the safety of the contractor’s patients, or

• (b) protect itself from material financial loss,

sub-paragraphs (3) and (4) do not apply and the Local Health Board is entitled to confirm, by written notice to be served on the contractor, that the contract is to nevertheless terminate at the end of the period of the notice it served pursuant to paragraph 118, 119, 120, 122(4) or 122(6) or 123(2).

Consultation with the Local Medical Committee

127

• (1) Whenever the Local Health Board is considering—

• (a) terminating the contract pursuant to paragraph 118, 119, 120, 122(4) or 122(6) or 123,

• (b) which of the alternative notices in writing available under the provisions of paragraph 121 it will serve, or

• (c) imposing a contract sanction,

it must, whenever it is reasonably practicable to do so, consult the Local Medical Committee for its area before it terminates the contract, serves a notice in writing or imposes a contract sanction.

• (2) Whether or not the Local Medical Committee has been consulted pursuant to sub-paragraph (1), whenever the Local Health Board imposes a contract sanction on a contractor or terminates a contract pursuant to this Part, it must, as soon as reasonably practicable, notify the Local Medical Committee in writing of the contract sanction imposed or of the termination of the contract (as the case may be).

PART 12 — Miscellaneous

Clinical governance

128

• (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 has responsibility for ensuring the effective operation of the system of clinical governance.

• (3) The contractor must engage in discussion and peer review of clinical incidents that have occurred within the practice and local services.

• (4) Components of the ‘system of clinical governance’ include, but are not limited to, the contractor—

• (a) undertaking annually by 31 March—

• (i) the Clinical Governance Practice Self-Assessment Tool, and

• (ii) the Information Governance Toolkit,

and submitting evidence of completion to the Local Health Board on request, and

• (b) complying with the Assurance Framework and the Local Health Board’s use of that Assurance Framework in relation to the contractor.

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

• (6) In this paragraph—

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

• “controlled drugs” (“cyffuriau a reolir”) 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).

Co-operation with Health Education and Improvement Wales

129

The contractor must co-operate with Health Education and Improvement Wales where Health Education and Improvement Wales is discharging functions it has been directed to exercise by the Welsh Ministers relating to—

• (a) the provision of services under Part 4 of the Act, or

• (b) persons who are employed or engaged, or who are considering becoming employed or engaged, in any activity which involves or is connected with the provision of services under Part 4 of the Act.

Insurance

130

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

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

• (2A) For the purposes of sub-paragraph (3), any reference to “the contractor” is to be read as including—

• (a) in the case of a contract with a partnership, any partner in the partnership, and

• (b) in the case of a contract with a company limited by shares, any person legally or beneficially owning a share in the company and any director or secretary of the company.

• (3) The Local Health Board, to the extent it considers reasonable and to the extent it is reimbursed in accordance with the Clinical Negligence Scheme for NHS Trusts and Local Health Boards established by regulation 3 of the 2019 Regulations, must indemnify the contractor in respect of that contractor’s qualifying liabilities as specified in regulation 9(4) of the 2019 Regulations, provided the contractor—

• (a) complies with the Local Health Board’s claims management protocol for contractors (as amended from time to time); and

• (b) does not have any other indemnity arrangement in force in connection with clinical services which the contractor provides under the contract at the time the qualifying liability arose.

• (4) For the purposes of this paragraph a contractor is regarded as having in force in relation to it an indemnity arrangement—

• (a) if there is an indemnity arrangement in force in relation to a person employed or engaged by it in connection with clinical services which that person provides under the contract or, as the case may be, sub-contract, or

• (b) for its qualifying liabilities specified in regulation 9(4) of the 2019 Regulations, to the extent provided for under sub-paragraph (3).

• (5) In this paragraph—

• “the 2019 Regulations” (“Rheoliadau 2019”) means the National Health Service (Clinical Negligence Scheme) (Wales) Regulations 2019⁷²;

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

• “indemnity arrangement” (“trefniant indemniad”) means a contract of insurance or other arrangement made for the purpose of indemnifying the contractor.

Public liability insurance

131

The contractor must at all times hold adequate public liability insurance in relation to liabilities to third parties arising under or in connection with the contract which are not covered by the indemnity arrangement referred to in paragraph 130.

Gifts

132

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

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

• (i) a patient,

• (ii) a relative of a patient, or

• (iii) any person who provided or wishes to provide services to the contractor or its patients in connection with the contract, and

• (b) have, in its reasonable opinion, an individual value of more than £100.00.

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

• (a) the contractor,

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

• (c) where the contract is with a company limited by shares—

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

• (ii) a director or secretary of the company,

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

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

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

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

• (3) Sub-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

• (c) the contractor is not aware that the donor wishes to provide services to the contractor or its patients.

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

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

• (a) the name of the donor,

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

• (c) in any other case, the address of the donor,

• (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 the Local Health Board on request.

Bribery Act

133

• (1) The contractor must not commit any prohibited act.

• (2) If the contractor or its employees or agents (or anyone acting on its or their behalf) commits any prohibited act in relation to the contract with or without the knowledge of the Local Health Board, the Local Health Board is entitled to—

• (a) exercise its right to terminate under paragraph 119 and to recover from the contractor the amount of any loss resulting from the termination,

• (b) recover from the contractor the amount or value of any gift, consideration or commission concerned, and

• (c) recover from the contractor any loss or expense sustained in consequence of the carrying out of the prohibited act or the commission of the offence.

Advertising private services

134

A contractor who offers private services which are not available to patients through the NHS must advertise those private services clearly and separately to the services available under the contract.

Compliance with legislation and guidance

135

• (1) The contractor must comply (and the contractor must ensure that those it employs or engages comply) with—

• (a) all relevant legislation, and

• (b) all relevant guidance and codes of practice issued from time to time by—

• (i) the Local Health Board, Welsh Ministers or local authorities in respect of the exercise of their functions under the Act, or

• (ii) any regulatory or supervisory body.

• (2) The contractor must provide the services under the contract in a manner that assists the Local Health Board to comply with the Health and Care Standards and Duty of Quality Guidance in which those standards are set.

Third party rights

136

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

SCHEDULE 4 — Provision of information to patients

Information to be included on a practice’s online resource and written practice leaflet

1

A contractor’s online resource and written practice leaflet must include—

• (a) the name of the contractor;

• (b) in the case of a contract with a partnership—

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

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

• (c) in the case of a contract with a company—

• (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;

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

• (e) in the case of each health care professional performing services under the contract the health care professional’s professional qualifications;

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

• (g) the contractor’s practice area, by reference to a sketch diagram, plan or postcode;

• (h) the address of each of the practice premises;

• (i) the contractor’s telephone and fax numbers and the address of its online resource;

• (j) whether the practice premises have suitable access for disabled patients and, if not, the alternative arrangements for providing services to such patients;

• (k) how to register as a patient;

• (l) the right of patients to express a preference of practitioner in accordance with paragraph 27 of Schedule 3 and the means of expressing such a preference;

• (m) the services available under the contract;

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

• (o) the criteria for home visits and the method of obtaining such a visit;

• (p) the consultations available to patients under regulation 17 and Part 1 of Schedule 3;

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

• (r) if the services in sub-paragraph (q) are not provided by the contractor, the fact that the Local Health Board referred to in sub-paragraph (bb) is responsible for commissioning the services;

• (s) the name and address of any local walk-in centre;

• (t) the telephone number of NHS 111 Wales and details of NHS 111 Wales online;

• (u) the method by which patients are to 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 subject to paragraph 60(2)(b) of Schedule 3;

• (x) how patients may notify a concern or complaint in accordance with the provisions of the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations 2011, or comment on the provision of the contractor’s services;

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

• (z) the action that may be taken where a patient is violent or abusive to the contractor or his staff or other persons on the practice premises or in the place where treatment is provided under the contract or other persons specified in paragraph 30 of Schedule 3;

• (aa) details of who has access to patient information (including information from which the identity of the individual can be ascertained), the patient’s rights in relation to disclosure of such information and how patients can access the contractor’s privacy notice or privacy policy;

• (bb) the name, address and telephone number of the Local Health Board which is a party to the contract and from whom details of primary medical services in the area may be obtained; and

• (cc) the fees charged for non-NHS services that are not private services.

SCHEDULE 5 — Consequential amendments

1

• (1) The National Health Service (Performers Lists) (Wales) Regulations 2004⁷³ are amended as follows.

• (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• (3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

• (1) The National Health Service (Pharmaceutical Services) (Wales) Regulations 2020⁷⁴ are amended as follows.

• (2) In regulation 2 (interpretation)—

• (a) in paragraph (1) in the definition of—

• (i) “appropriate non-proprietary name” for—

• (aa) “42(2)” substitute “56(2)”, and

• (bb) “6” substitute “3”;

• (ii) “GMS Regulations” for “2004” substitute “2023”;

• (iii) “patient list” for—

• (aa) “14” substitute “22”, and

• (bb) “6” substitute “3”;

• (iv) “repeatable prescriber” in each place it occurs for—

• (aa) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• (bb) “6” substitute “3”;

• (b) in paragraph (3)(b) for—

• (i) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• (ii) “6” substitute “3”.

• (3) In Schedule 7—

• (a) in paragraph 5 (dispensing of drugs and appliances ordered by the dispensing doctor)—

• (i) in sub-paragraph (a) for “paragraph 39 of Schedule 6” substitute “paragraphs 49 and 50 of Schedule 3”, and

• (ii) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• (b) in paragraph 9(1) (fees and charges) for “regulation 24 of, and Schedule 5 to,” substitute “regulations 21 and 22 of”;

• (c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SCHEDULE 6 — Revocation

1

The 2004 Regulations are revoked.

Signed

Eluned Morgan — Minister for Health and Social Services, one of the Welsh Ministers — 1 September 2023

Explanatory note

(This note is not part of the Regulations)

EXPLANATORY NOTE

These Regulations set out, for Wales, the framework for general medical services contracts under section 42 of the National Health Service Act 2006 (“the Act”).

Part 2 of the Regulations prescribes the conditions which, in accordance with section 44 of the Act, must be met by a contractor before the Local Health Board may enter into a general medical services contract with it.

Part 3 of the Regulations prescribes the procedure for pre-contract dispute resolution, in accordance with section 48(2) of the Act. Part 3 applies to cases where the contractor is not a health service body. In cases where the contractor is such a body, the procedure for dealing with pre-contract disputes is set out in section 7 of the Act.

Part 4 of the Regulations sets out the procedures, in accordance with section 48(3) of the Act, by which the contractor may obtain health service body status.

Part 5 of (and Schedules 1 to 4 to) the Regulations prescribe the terms which, in accordance with sections 47 and 48 of the Act, must be included in a general medical services contract (in addition to those contained in the Act). It includes, in regulation 17, a description of the services which must be provided to patients under general medical services contracts pursuant to section 43 of the Act.

The prescribed terms include terms relating to—

• (a) the type and duration of the contract (regulations 14 to 16);

• (b) the services to be provided (regulations 17 and 18 and Schedule 2) and the manner in which they are to be provided (Schedule 3);

• (c) the issuing of medical certificates (regulation 19 and Schedule 1);

• (d) finance, fees and charges (regulations 20 to 22);

• (e) patient registration and removal, lists closures and assignments (Schedule 3, Parts 2 to 4);

• (f) prescribing and dispensing (Schedule 3, Part 5);

• (g) the conditions to be met by those who perform services or are employed or engaged by the contractor (Schedule 3, Part 6);

• (h) sub-contracting (Schedule 3, Part 7);

• (i) patient records, the provision of information and rights of entry (Schedule 3, Part 8 and Schedule 4);

• (j) concerns, complaints and investigations (Schedule 3, Part 9);

• (k) procedures for dispute resolution (Schedule 3, Part 10);

• (l) procedures for variation and termination of contracts (Schedule 3, Part 11).

Part 6 of the Regulations prescribes functions for Local Medical Committees.

Part 7 of the Regulations and Schedules 5 to 6 make transitional provisions and provision for saving, consequential amendments and revocations.

Footnotes