National Health Service (Wales) Act 2006 (c. 42)

(The document as of February, 2008)

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(4) The power under subsection (3) may in particular be exercised so as to require, in such circumstances as may be specified--

(a) repayment of the whole or part of a payment under this section, or

(b) in respect of property acquired with payments under this section, payment of an amount representing the whole or part of an increase in the value of the property which has occurred since its acquisition.

(5) No payment may be made under this section in respect of any expenditure unless the conditions relating to it conform with the conditions prescribed for payments of that description under subsection (3).

35 Care Trusts

(1) Where--

(a) an NHS trust is, or will be, a party to any existing or proposed LA delegation arrangements, and

(b) the Welsh Ministers consider that designation of the NHS trust as a Care Trust would be likely to promote the effective exercise by the NHS trust of prescribed health-related functions of a local authority (in accordance with the arrangements) in conjunction with prescribed NHS functions of the NHS trust,

the Welsh Ministers may designate the NHS trust as a Care Trust.

(2) An NHS trust may, however, be designated only in pursuance of an application made to the Welsh Ministers jointly by each prescribed body.

(3) If the application under subsection (2) requests the Welsh Ministers to do so, they may when designating an NHS trust as a Care Trust make a direction under subsection (4).

(4) The direction is that, while it is designated, the NHS trust may (in addition to exercising health-related functions of the local authority as mentioned in subsection (1)(b)) exercise such prescribed health-related functions of the local authority as are specified in the direction in relation to persons in any area so specified, even though it does not exercise any NHS functions in relation to persons in that area.

(5) Where an NHS trust is designated as a Care Trust under this section--

(a) its designation may be revoked by the Welsh Ministers at any time--

(i) of their own motion, and

(ii) after such consultation as they consider appropriate,

(b) if an application for the revocation of its designation is made to the Welsh Ministers by one or more of the parties to the LA delegation arrangements, its designation must be revoked by the Welsh Ministers at the earliest time at which they consider it practicable to do so, having regard, in particular, to any steps that need to be taken in relation to those arrangements in connection with the revocation.

(6) The designation of an NHS trust as a Care Trust under this section must be effected by an order under section 18 which--

(a) (in the case of an existing NHS trust) amends the order establishing the NHS trust so as to change its name to one that includes the words "Care Trust", or

(b) (in the case of a new NHS trust) establishes the NHS trust with a name that includes those words,

and any revocation of its designation must be effected by a further order under section 18 which makes such provision for changing the name of the NHS trust as the Welsh Ministers consider expedient.

(7) The power of the Welsh Ministers to dissolve an NHS trust includes power to dissolve an NHS trust where they consider that it is appropriate to do so in connection with the designation of any other NHS trust (whether existing or otherwise) as a Care Trust.

(8) Regulations may make such incidental, supplementary or consequential provision (including provision amending, repealing or revoking enactments) as the Welsh Ministers consider expedient in connection with the preceding provisions of this section.

(9) Regulations under subsection (8) may, in particular, make provision--

(a) prescribing--

(i) the manner and circumstances in which, and

(ii) any conditions which must be satisfied before,

an application may be made for an NHS trust to be designated as a Care Trust under this section, or to cease to be so designated, and the information to be supplied with such an application,

(b) enabling the Welsh Ministers to terminate appointments of persons as members of the board of directors of an NHS trust (or of a committee of such a trust) where they consider that it is appropriate to do so in connection with the designation of the NHS trust as a Care Trust,

(c) requiring the consent of the Welsh Ministers to be obtained before any prescribed change is made with respect to the governance of an NHS trust so designated,

(d) for supplementing or modifying, in connection with the operation of subsection (3), any provision made by regulations under section 33.

(10) The designation of an NHS trust as a Care Trust under this section does not affect any of the functions, rights or liabilities of that NHS trust in its capacity as an NHS trust.

(11) In connection with the exercise by an NHS trust so designated of any relevant social services functions under LA delegation arrangements--

(a) section 7 of the Local Authority Social Services Act 1970 (c. 42) (authorities to exercise social services functions under guidance), and

(b) section 7A of that Act (directions as to exercise of such functions),

apply to the NHS trust as if it were a local authority within the meaning of that Act.

(12) In this section--

"health-related functions" has the meaning given by section 33(8),
"LA delegation arrangements" means arrangements falling within section 33(2)(b), whether or not made in conjunction with any pooled fund arrangements,
"NHS functions" means functions exercisable by an NHS trust in its capacity as such,
"pooled fund arrangements" means arrangements falling within section 33(2)(a),
"relevant social services functions" means health-related functions which are social services functions within the meaning of the Local Authority Social Services Act 1970.

36 Directed partnership arrangements

(1) If the Welsh Ministers are of the opinion--

(a) that a body to which this section applies ("the failing body") is not exercising any of its functions adequately, and

(b) that it would be likely to lead to an improvement in the way in which that function is exercised if it were to be exercised--

(i) by another body to which this section applies under delegation arrangements, or

(ii) in accordance with pooled fund arrangements made with another such body,

the Welsh Ministers may direct those bodies to enter into such delegation arrangements or pooled fund arrangements in relation to the exercise of the appropriate function or functions as are specified in the direction.

(2) In subsection (1) "the appropriate function or functions" means--

(a) the function of the failing body mentioned in that subsection, and

(b) such other function of that body (if any) as the Welsh Ministers consider would, if exercised under or in accordance with the arrangements in question, be likely to contribute to an improvement in the exercise of the function referred to in paragraph (a).

(3) The bodies to which this section applies are--

(a) Strategic Health Authorities,

(b) Primary Care Trusts,

(d) Local Health Boards, and

(e) local authorities,

but in subsections (1) and (2) any reference to functions is, in relation to a local authority, a reference only to relevant social services functions of the authority.

(4) In this section any reference to an improvement in the way in which any function is exercised includes an improvement in the provision to any individuals of any services to which that function relates.

(5) In this section--

"delegation arrangements" means arrangements falling within section 33(2)(b) or (2)(c), whether or not made in conjunction with any pooled fund arrangements,
"health-related functions" has the meaning given by section 33(8),
"pooled fund arrangements" means arrangements falling within section 33(2)(a),
"relevant social services functions" means health-related functions which are social services functions within the meaning of the Local Authority Social Services Act 1970 (c. 42).

37 Further provisions about directions and directed partnership arrangements

(1) A direction under section 36(1) (a "principal direction") may make provision with respect to--

(a) any of the matters with respect to which provision is required to be made by the specified arrangements by virtue of regulations under section 33, and

(b) such other matters as the Welsh Ministers consider appropriate.

(2) The Welsh Ministers may in particular (either in a principal direction or in any subsequent direction) make provision--

(a) for the determination, whether--

(i) by agreement, or

(ii) (in default of agreement) by the Welsh Ministers or an arbitrator appointed by them,

of the amount of any payments which need to be made by one body to another for the purposes of the effective operation of the specified arrangements, and for the variation of any such determination,

(b) specifying the manner in which the amount of any such payments must be so determined (or varied),

(c) requiring a body specified in the direction to supply to the Welsh Ministers or an arbitrator, for the purpose of enabling any such amount to be so determined (or varied), such information or documents as may be so specified,

(d) requiring any amount so determined (or varied) to be paid by and to such bodies as are specified in the direction,

(e) requiring capital assets specified in the direction to be made available by and to such bodies as are so specified.

(3) The Welsh Ministers may, when giving a principal direction to any bodies to which section 36 applies, give such directions to any other such body as they consider appropriate for or in connection with securing that full effect is given to the principal direction.

(4) Before giving a principal direction to any bodies to which section 36 applies, the Welsh Ministers may--

(a) direct either or both of the bodies in question to take such steps specified in the direction, or

(b) give such other directions,

as the Welsh Ministers consider appropriate with a view to enabling them to determine whether the principal direction should be given.

(5) The revocation of a principal direction does not affect the continued operation of the specified arrangements.

(6) "The specified arrangements", in relation to a principal direction, means the arrangements specified in the direction in pursuance of section 36(1).

38 Supply of goods and services by the Welsh Ministers

(1) The Welsh Ministers may supply to--

(a) local authorities, and

(b) such public bodies or classes of public bodies as the Welsh Ministers may determine,

any goods or materials of a kind used in the health service.

(2) In subsection (1) "public bodies" includes public bodies in Northern Ireland.

(3) The Welsh Ministers may make available to persons falling within subsection (1)--

(a) any facilities provided by them or by a Primary Care Trust for any service under this Act, and

(b) the services of persons employed by the Welsh Ministers or by a Local Health Board, a Primary Care Trust or a Special Health Authority.

(4) The Welsh Ministers may carry out maintenance work (including minor renewals, minor improvements and minor extensions) in connection with any land or building for the maintenance of which a local authority is responsible.

(5) The Welsh Ministers may supply or make available to persons--

(a) providing general ophthalmic services or pharmaceutical services,

(b) providing services under a general medical services contract or a general dental services contract, or

such goods, materials or other facilities as may be prescribed.

(6) The Welsh Ministers must make available to local authorities--

(a) any services (other than the services of any person) or other facilities provided under this Act,

(b) the services provided as part of the health service by any person employed by the Welsh Ministers, a Primary Care Trust, a Special Health Authority or a Local Health Board, and

(c) the services of any medical practitioner, dental practitioner or nurse employed by the Welsh Ministers, a Primary Care Trust, a Special Health Authority or a Local Health Board otherwise than to provide services which are part of the health service,

so far as is reasonably necessary and practicable to enable local authorities to discharge their functions relating to social services, education and public health.

(7) The Welsh Ministers may arrange to make available to local authorities the services of persons--

(a) providing general ophthalmic services or pharmaceutical services,

(b) performing services under a general medical services contract or a general dental services contract,

(d) providing Local Health Boards, Primary Care Trusts or Special Health Authorities with services of a kind provided as part of the health service,

so far as is reasonably necessary and practicable to enable local authorities to discharge their functions relating to social services, education and public health.

39 Conditions of supply under section 38

(1) The Welsh Ministers must, before they make available the services of any officer under subsection (3)(b) of section 38, or subsection (6)(b) or (c) of that section--

(a) consult the officer or a body recognised by the Welsh Ministers as representing the officer, or

(b) satisfy themselves that the body who employs the officer has consulted the officer about the matter.

(2) The Welsh Ministers may disregard the provisions of subsection (1) in a case where they--

(a) consider it necessary to make the services of an officer available for the purpose of dealing temporarily with an emergency, and

(b) have previously consulted a body such as is mentioned in subsection (1)(b) about making services available in an emergency.

(3) The Welsh Ministers may, for the purposes of subsection (3)(b) of section 38, or subsection (6)(b) or (c) of that section, give such directions to Primary Care Trusts, Special Health Authorities and Local Health Boards to make the services of their officers available as the Welsh Ministers consider appropriate.

(4) Powers under this section and section 38 may be exercised on such terms as may be agreed, including terms as to the making of payments to the Welsh Ministers.

(5) The Welsh Ministers may make such charges in respect of services or facilities provided under section 38(6) as may be agreed between the Welsh Ministers and the local authority or, in default of agreement, as may be determined by arbitration.

(6) Any power to supply goods or materials under section 38 includes--

(a) a power to purchase and store them, and

(b) a power to arrange with third parties for the supply of goods or materials by those third parties.

40 Health and well-being strategies in Wales

(1) Each local authority in Wales, and each Local Health Board any part of whose area lies within the area of the local authority, must jointly formulate and implement a strategy for the health and well-being of members of the public in the local authority's area (a "health and well-being strategy").

(2) The local authority and the Local Health Board (or Boards) responsible for a health and well-being strategy are referred to in this section as the "responsible bodies".

(3) The responsible bodies must have regard to their strategy in the exercise of their functions.

(4) Each strategy must be formulated in relation to a period of time specified in regulations.

(5) The Welsh Ministers may by regulations make further provision about health and well-being strategies.

(6) The regulations may, in particular, make provision as to--

(a) the imposition of a duty on the responsible bodies to co-operate in formulating their strategy with prescribed persons or descriptions of person (including, for example, NHS trusts, Community Health Councils, voluntary bodies, and local businesses),

(b) steps which the responsible bodies must take before formulating the strategy,

(d) publication of the strategy,

(e) monitoring and review by the responsible bodies of the strategy and its implementation,

(f) the production of information and reports by the responsible bodies in relation to the strategy,

(g) the avoidance of duplication in the preparation of health and well-being strategies and other prescribed strategies or plans provided for under any other enactment.

(7) The Welsh Ministers may--

(a) give directions to local authorities in Wales, Local Health Boards and NHS trusts in connection with health and well-being strategies,

(b) issue guidance to responsible bodies in connection with them.

(8) The power to give directions under subsection (7)(a) does not affect any other power to give directions.

(9) In this section--

"local authority" means a county council or county borough council,
"NHS trust" means an NHS trust all or most of whose hospitals, establishments and facilities are situated in Wales.

Part 4 Medical services

Duty of Local Health Boards in relation to primary medical services

41 Primary medical services

(1) Each Local Health Board must, to the extent that it considers necessary to meet all reasonable requirements, exercise its powers so as to provide primary medical services within its area, or secure their provision within its area.

(2) A Local Health Board may (in addition to any other power conferred on it)--

(a) provide primary medical services itself (whether within or outside its area),

(b) make such arrangements for their provision (whether within or outside its area) as it considers appropriate, and may in particular make contractual arrangements with any person.

(3) Each Local Health Board must publish information about such matters as may be prescribed in relation to the primary medical services provided under this Act.

(4) Each Local Health Board must co-operate with each other Local Health Board and each Primary Care Trust in the discharge of their respective functions relating to the provision of primary medical services under this Act and the National Health Service Act 2006 (c. 41).

(5) Regulations may provide that services of a prescribed description must, or must not, be regarded as primary medical services for the purposes of this Act.

(6) Regulations under this section may in particular describe services by reference to the manner or circumstances in which they are provided.

General medical services contracts

42 General medical services contracts: introductory

(1) A Local Health Board may enter into a contract under which primary medical services are provided in accordance with the following provisions of this Part.

(2) A contract under this section is called in this Act a "general medical services contract".

(3) A general medical services contract may make such provision as may be agreed between the Local Health Board and the contractor or contractors in relation to--

(a) the services to be provided under the contract,

(b) remuneration under the contract, and

(4) The services to be provided under a general medical services contract may include--

(a) services which are not primary medical services,

(b) services to be provided outside the area of the Local Health Board.

(5) In this Part, "contractor", in relation to a general medical services contract, means any person entering into the contract with the Local Health Board.

43 Requirement to provide certain primary medical services

(1) A general medical services contract must require the contractor or contractors to provide, for his or their patients, primary medical services of such descriptions as may be prescribed.

(2) Regulations under subsection (1) may in particular describe services by reference to the manner or circumstances in which they are provided.

44 Persons eligible to enter into GMS contracts

(1) A Local Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with--

(a) a medical practitioner,

(b) two or more individuals practising in partnership where the conditions in subsection (2) are satisfied, or

(2) The conditions referred to in subsection (1)(b) are that--

(a) at least one partner is a medical practitioner, and

(b) any partner who is not a medical practitioner is either--

(i) an NHS employee,

(ii) a section 50 employee, section 64 employee, section 92 employee, section 107 employee, section 17C employee or Article 15B employee,

(iii) a health care professional who is engaged in the provision of services under this Act or the National Health Service Act 2006 (c. 41), or

(iv) an individual falling within section 51(1)(d).

(3) The conditions referred to in subsection (1)(c) are that--

(a) at least one share in the company is legally and beneficially owned by a medical practitioner, and

(b) any share which is not so owned is legally and beneficially owned by a person referred to in subsection (2)(b).

(4) Regulations may make provision as to the effect, in relation to a general medical services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.

(5) In this section--

"health care professional", "NHS employee", "section 50 employee", "section 64 employee", "section 92 employee", "section 107 employee", "section 17C employee" and "Article 15B employee" have the meaning given by section 51.

45 GMS contracts: payments

(1) The Welsh Ministers may give directions as to payments to be made under general medical services contracts.

(2) A general medical services contract must require payments to be made under the contract in accordance with directions under this section.

(3) Directions under subsection (1) may in particular--

(a) provide for payments to be made by reference to compliance with standards or the achievement of levels of performance,

(b) provide for payments to be made by reference to--

(i) any scheme or scale specified in the direction, or

(ii) a determination made by any person in accordance with factors specified in the direction,

(d) provide that the whole or any part of a payment is subject to conditions (and may provide that payments are payable by a Local Health Board only if it is satisfied as to certain conditions),

(e) make provision having effect from a date before the date of the direction, provided that, having regard to the direction as a whole, the provision is not detrimental to the persons to whose remuneration it relates.

(4) Before giving a direction under subsection (1), the Welsh Ministers--

(a) must consult any body appearing to them to be representative of persons to whose remuneration the direction would relate, and

(b) may consult such other persons as they consider appropriate.

(5) "Payments" includes fees, allowances, reimbursements, loans and repayments.

46 GMS contracts: prescription of drugs, etc

(1) A general medical services contract must contain provision requiring the contractor or contractors to comply with any directions given by the Welsh Ministers for the purposes of this section as to the drugs, medicines or other substances which may or may not be ordered for patients in the provision of medical services under the contract.

(2) A direction under this section must, subject to subsection (3), be given by regulations.

(3) A direction under this section may be given by an instrument in writing where it gives effect to a request made in writing to the Welsh Ministers by a person who is a holder of a Community marketing authorization or United Kingdom marketing authorisation in respect of the drug, medicine or other substance to which the request relates.

(4) "Community marketing authorization" and "United Kingdom marketing authorisation" have the meaning given by regulation 1 of the Medicines for Human Use (Marketing Authorisations Etc.) Regulations 1994 (S.I. 1994/3144).

47 GMS contracts: other required terms

(1) A general medical services contract must contain such provision as may be prescribed (in addition to the provision required by the preceding provisions of this Part).

(2) Regulations under subsection (1) may in particular make provision as to--

(a) the manner in which, and standards to which, services must be provided,

(b) the persons who perform services,

(d) the variation of contract terms (other than terms required by or under this Part),

(e) rights of entry and inspection (including inspection of clinical records and other documents),

(f) the circumstances in which, and the manner in which, the contract may be terminated,

(g) enforcement,

(h) the adjudication of disputes.

(3) Regulations making provision under subsection (2)(c) may make provision as to the circumstances in which a contractor or contractors--

(a) must or may accept a person as a patient to whom services are provided under the contract,

(b) may decline to accept a person as such a patient, or

(4) Regulations under subsection (2)(d) may--

(a) make provision as to the circumstances in which a Local Health Board may impose a variation of contract terms,

(b) make provision as to the suspension or termination of any duty under the contract to provide services of a prescribed description.

(5) Regulations making provision of the kind described in subsection (4)(b) may prescribe services by reference to the manner or circumstances in which they are provided.

(6) Regulations under subsection (1) must make provision as to the right of patients to choose the persons from whom they receive services.

48 GMS contracts: disputes and enforcement

(1) Regulations may make provision for the resolution of disputes as to the terms of a proposed general medical services contract.

(2) Regulations under subsection (1) may make provision--

(a) for the referral of the terms of the proposed contract to the Welsh Ministers, and

(b) for the Welsh Ministers, or a person appointed by them, to determine the terms on which the contract may be entered into.

(3) Regulations may make provision for a person or persons entering into a general medical services contract to be regarded as a health service body for any purposes of section 7, in circumstances where he or they so elect.

(4) Regulations under subsection (3) may include provision as to the application of section 7 in cases where--

(a) persons practising in partnership elect to become a health service body, and

(b) there is a change in the membership of the partnership.

(5) Where--

(a) by virtue of regulations under subsection (3), section 7(11) applies in relation to a general medical services contract, and

(b) a direction as to payments is made under that subsection in relation to the contract,

the direction is enforceable in a county court (if the court so orders) as if it were a judgment or order of that court.

Performance of primary medical services

49 Persons performing primary medical services

(1) Regulations may provide that a health care professional of a prescribed description may not perform any primary medical service for which a Local Health Board is responsible unless he is included in a list maintained under the regulations by a Local Health Board.

(2) For the purposes of this section--

(a) "health care professional" means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002 (c. 17),

(b) a Local Health Board is responsible for a medical service if it provides the service, or secures its provision, by or under any enactment.

(3) Regulations under this section may make provision in relation to lists under this section and in particular as to--

(a) the preparation, maintenance and publication of a list,

(b) eligibility for inclusion in a list,

(c) applications for inclusion (including provision as to the Local Health Board to which an application must be made, and for the procedure for applications and the documents to be supplied on application),

(d) the grounds on which an application for inclusion may or must be granted or refused,

(e) requirements with which a person included in a list must comply (including the declaration of financial interests and gifts and other benefits),

(f) suspension or removal from a list (including provision for the grounds for, and consequences of, suspension or removal),

(g) circumstances in which a person included in a list may not withdraw from it,

(h) payments to be made in respect of a person suspended from a list (including provision for the amount of the payment, or the method of calculating the payment, to be determined by the Welsh Ministers or a person appointed by them),

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