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Statutory Instrument 1998 No. 2838
The National Health Service (General Medical Services) Amendment (No. 2) Regulations 1998
(The document as of February, 2008)
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STATUTORY INSTRUMENTS
1998 No. 2838
NATIONAL HEALTH SERVICE, ENGLAND AND WALES
The National Health Service (General Medical Services) Amendment (No. 2) Regulations 1998
| | Made | 18th November 1998 | | | | Laid before Parliament | 19th November 1998 | | | | Coming into force | 10th December 1998 | |
The Secretary of State for Health, in exercise of powers conferred on him by sections 7, 29, 29A(4), 29B, 31, 34, 45(1) and 126(4) of, and paragraph 1(3) of Schedule 10 to, the National Health Service Act 1977[1], and of all other powers enabling him in that behalf, hereby makes the following Regulations: - Citation, commencement and interpretation 1. - (1) These Regulations may be cited as the National Health Service (General Medical Services) Amendment (No. 2) Regulations 1998 and shall come into force on 10th December 1998. (2) In these Regulations, "the principal Regulations" means the National Health Service (General Medical Services) Regulations 1992[2]. Amendment of regulation 2 of the principal Regulations 2.In regulation 2(1) of the principal Regulations (interpretation) - (a) in the definition of "full-time doctor", for "15(1)(a)" substitute "13(2)(a)";
(b) in the definition of "half-time doctor", for "15(1)(c)" substitute "13(2)(c)";
(c) in the definition of "job-sharing doctor", for "15(1)(d)" substitute "13(2)(d)";
(d) in the definition of "locality", at the end, insert -
" but in relation to Part III of, and Schedule 3 to, these Regulations, shall be construed in accordance with regulation 11(7)";
(e) in the definition of "restricted doctor", for "15(1)(e)" substitute "13(2)(e)";
(f) in the definition of "three-quarter-time doctor", for "15(1)(b)" substitute "13(2)(b)"; and
(g) in the appropriate alphabetical position, insert -
" "a replacement doctor" means a replacement full-time doctor nominated by the remaining members of a partnership in accordance with the provisions of regulations 18H and 18I;".
Amendment of regulation 4 of the principal Regulations
3.Regulation 4 of the principal Regulations (medical list) is amended as follows -
(a) in paragraph (1)(a), for "30" substitute "29A";
(b) in paragraph (3), for "15" substitute "13(1)(b)"; and
(c) in paragraph (5)(f), omit the words "or, on appeal, by the Secretary of State".
Amendment of regulation 6 of the principal Regulations
4.In regulation 6 of the principal Regulations (amendment of or withdrawal from the medical list), for paragraph (5) substitute -
" (5) Where a Health Authority applies to the Medical Practices Committee for the variation of any condition imposed or treated as imposed pursuant to regulation 13(1)(b)[3], and the Medical Practices Committee grants such variation, the Health Authority shall amend the medical list by transferring the name of that doctor to that part of the list which, having regard to the nature of the condition as varied, is appropriate in his case by virtue of regulation 4(2).".
General practitioner practice vacancies
5. - (1) For Part III of the principal Regulations, substitute the new Part III set out in Schedule 1 to these Regulations.
(2) In consequence of paragraph (1), regulation 5 of the principal Regulations (application for inclusion in the medical list or to succeed to a vacancy) is omitted.
(3) As a further consequence of paragraph (1), after regulation 39 of the principal Regulations insert the following regulation -
" Certificate that transaction does not involve sale of goodwill
40.A certificate issued by the Medical Practices Committee under paragraph 1(3) of Schedule 10 to the Act shall be in the form set out in Schedule 7.".
Amendment of regulation 25 of the principal Regulations
6.Regulation 25 of the principal Regulations (temporary provision of services) is amended as follows -
(a) in paragraph (16), sub-paragraph (b), and the word "and" at the end of sub-paragraph (a), are omitted; and
(b) after paragraph (16) add -
" (17) No doctor shall be appointed under this regulation unless he is able to satisfy the Health Authority that he has that knowledge of English which, in the interests of himself and his patients, is necessary for the provision of general medical services in the Authority's area.".
Amendment of Schedule 2 to the principal Regulations
7.In Schedule 2 to the principal Regulations (terms of service for doctors), in paragraph 32 (which restricts the carrying on of a medical practice at premises previously used by a different doctor), for sub-paragraph (2) substitute -
" (2) In this paragraph "successor" means the doctor approved or nominated by a Health Authority in accordance with regulation 18A, 18B, 18C or 18I, and "the date on which the successor was appointed" means the date on which the successor is notified of such nomination or approval, or where an appeal lies to the Secretary of State under regulation 18G -
(a) the date on which the successor is notified that no appeal has been made to the Secretary of State; or
(b) in the event of an appeal, the date on which the successor is notified of the Secretary of State's decision to dismiss the appeal.".
Amendment of Schedule 3 to the principal Regulations
8.In Schedule 3 to the principal Regulations, for Parts I, II, IIIA, IIIB, IIIC, IIID, IV, V and VI, substitute Parts I, II and III as set out in Schedule 2 to these Regulations.
Existing circumstances
9. - (1) The amendments made by these regulations do not affect any application for inclusion in a medical list or to succeed to a practice vacancy made before 10th December 1998, and accordingly such an application, any appeal to the Secretary of State arising out of such an application, and any reconsideration of such an application in the event of such an appeal being successful, shall be dealt with as if the amendments made by these Regulations had not come into force.
(2) Nothing in these Regulations requires any alteration in the entry relating to a medical practitioner in a Health Authority medical list as it was immediately before these Regulations came into force.
Signed by authority of the Secretary of State for Health
Alan Milburn
Minister of State, Department of Health
18th November 1998
SCHEDULE 1Regulation 5(1) SUBSTITUTED PART III OF THE PRINCIPAL REGULATIONS" PART III
PRACTICE VACANCIES
Medical Practices Committee
Medical Practices Committee - appointment of members and tenure of office
10. - (1) Subject to paragraphs (2) to (4), the chairman and other members of the Medical Practices Committee shall be appointed for a period of three years expiring on 31st March in any year.
(2) A member may be re-appointed on the expiration of his term of office.
(3) A member may resign by giving notice in writing to the Secretary of State, and a member who is appointed as being a person actively engaged in medical practice shall be deemed to have resigned if he ceases to be so engaged.
(4) In the case of a vacancy in membership occasioned by death or by resignation (including deemed resignation under paragraph (3)), a person shall be appointed to fill the vacancy for the remainder of the period for which his predecessor was appointed, unless the remainder of that period is less than six months, in which case it shall not be necessary to appoint a replacement member until that remaining period has expired.
Identifying vacancies
References and reports to the Medical Practices Committee by a Health Authority
11. - (1) Subject to the following provisions of this regulation and to regulations 18H, 18I and 18J, in any of the circumstances mentioned in paragraph (2), a Health Authority must refer to the Medical Practices Committee, in writing, the question of whether there is, or will be, a vacancy for a doctor in a locality; and any such reference shall be accompanied by a report containing the information set out in Part I of Schedule 3.
(2) The circumstances are that -
(a) the Authority considers that it is appropriate to make a reference; or
(b) it has been asked to make a reference by a doctor who provides general medical services in the locality; or
(c) a doctor has died, or has withdrawn, or been removed, from the Authority's medical list,
and, in the case of sub-paragraph (b), where more than one request has been received the Health Authority shall make references to the Medical Practices Committee in the order in which such requests have been received by it (or, if such requests have been received at the same time, then in alphabetical order of name of doctor), and the Medical Practices Committee shall consider them in the same order.
(3) Subject to paragraph (4), where a doctor's prospective patients are situated in the area of more than one Health Authority, any of those Health Authorities may elect to deal separately with the prospective patients residing in its area and, where it does so elect, shall then make a reference to the Medical Practices Committee in accordance with paragraph (1).
(4) Where two or more Health Authorities agree to deal jointly with prospective patients residing in their areas, the Health Authority in whose area reside the largest number of the prospective patients of the additional doctor shall make the reference and report to the Medical Practices Committee under paragraph (1) and, where the Medical Practices Committee decides that there is a vacancy for an additional doctor in the locality, shall then (subject to paragraph (6)) proceed to deal with the vacancy in accordance with this Part of these Regulations.
(5) Where paragraph (4) applies, any Health Authority in whose area will reside any patient who is expected to be on the doctor's list of patients (other than the Health Authority which makes the reference pursuant to paragraph (1)) shall make a report to the Medical Practices Committee containing only the information set out in paragraphs 1, 5, 6 and 7 of Part I of Schedule 3, and shall send a copy of that report to the Health Authority making the reference under paragraph (1).
(6) In a case to which paragraph (4) applies, before -
(a) making a selection of a condition of practice pursuant to regulation 13(3);
(b) making a decision as to whether an additional doctor should be a member of a partnership or a sole practitioner pursuant to regulation 17(4);
(c) setting or agreeing criteria pursuant to regulation 18A(4), 18B(2) or (7) or 18D(5); or
(d) nominating or approving an additional doctor pursuant to regulation 18A, 18B or 18C,
the Health Authority shall consult any other Health Authority in whose area reside individuals who are expected to be on the doctor's list.
(7) For the purposes of this Part of these Regulations, where the prospective patients of a doctor reside in the area of two or more Health Authorities, or in the area of both a Health Authority and a Health Board, "locality" means the geographical area in which such patients reside.
Decisions of the Medical Practices Committee
12. - (1) On a reference under regulation 11, the Medical Practices Committee must decide whether the number of doctors undertaking to provide general medical services in the locality is adequate.
(2) When deciding on references under regulation 11, the Medical Practices Committee shall act in accordance with the following paragraphs of this regulation.
(3) In making its decision, the Medical Practices Committee must, in particular, take account of -
(a) any likely changes in the number of doctors in the locality; and
(b) any persons performing personal medical services in the locality pursuant to a pilot scheme.
(4) The Medical Practices Committee shall -
(a) take account of the report (and, in particular, the recommendation referred to in paragraph 9 of Part I of Schedule 3) made by the Health Authority (and any other Health Authority which has made a report pursuant to regulation 11(5)) with respect to the reference;
(b) where it declares a vacancy, consider in relation to any doctor who would fill that particular vacancy -
(i) which of the conditions set out in regulation 13(2) it is appropriate to specify, and
(ii) whether it should impose a condition pursuant to regulation 13(1)(c) (and if so, what that condition should be);
(c) specify the period (not exceeding 12 months) beginning with the date of the declaration of the vacancy after which a vacancy to which regulation 18A or 18B applies will automatically lapse by effluxion of time; and
(d) specify the date by which a vacancy for a sole practitioner must be advertised by the Health Authority pursuant to regulation 18D.
(5) Subject to paragraph (6), any determination of the Medical Practices Committee shall be the decision of the majority of those members who are present and voting at a meeting of the Committee.
(6) At any such meeting, four members of the Medical Practices Committee shall form a quorum, and in the case of an equality of votes the Chairman or, where the Chairman is absent for any reason, the person appointed to act as Chairman in his place shall have a second vote which shall be a casting vote.
(7) The Medical Practices Committee shall give notice in writing of its determination of a reference to the Health Authority which made the reference and to any other Health Authority which made a report pursuant to regulation 11(5), together with a written statement of the reasons for its decision.
(8) Upon receipt of the written determination and statement from the Medical Practices Committee, the Health Authority must send a copy of that determination and statement to -
(a) in all cases, the Local Medical Committee; and
(b) where regulation 11(2)(b) applies, the doctor concerned.
Declaration of vacancies
13. - (1) If the Medical Practices Committee decides that the number of doctors undertaking to provide general medical services in a locality is not adequate, it -
(a) must declare one or more vacancies for an additional doctor (and, if more than one, must specify how many);
(b) must specify, by reference to one or more conditions of practice relating to hours or the sharing of work, the provision of general medical services for which any additional doctor who is to fill a particular vacancy will be entitled to be remunerated; and
(c) may impose the condition that any additional doctor who is to fill a particular vacancy may provide general medical services only in such part of the locality as the Committee may specify.
(2) Subject to paragraph (3), the conditions referred to in paragraph (1)(b) are that a doctor shall provide such services as -
(a) a full-time doctor, that is to say a doctor who is to provide general medical services during not less than 26 hours in any week in which he is, pursuant to paragraph 29 of his terms of service, normally available to provide such services;
(b) a three-quarter-time doctor, that is to say a doctor who is to provide such services during less than 26 hours, but not less than 19 hours in any such week;
(c) a half-time doctor, that is to say a doctor who is to provide such services during less than 19 hours, but not less than 13 hours in any such week;
(d) a job-sharing doctor, that is to say a doctor -
(i) who is to practise in partnership with another doctor whose name is included in the medical list, and
(ii) who is himself to provide such services during less than 26 hours in any such week, and
(iii) for whom the hours during which he is to provide such services are, when aggregated with the hours of that other doctor, to amount to not less than 26 hours in any such week; or
(e) a restricted doctor, that is to say a doctor -
(i) who is a restricted list principal or a restricted services principal, and
(ii) who is to provide general medical services during such number of hours in any week as shall have been specified in a reference to the Medical Practices Committee pursuant to regulation 11.
(3) The Medical Practices Committee may specify, as alternatives, two or more of the conditions of practice set out in paragraph (2)(a) to (d) and, if it does so, the Health Authority shall select which one of those alternatives is to be imposed in relation to any doctor who would fill that particular vacancy.
(4) In a case to which paragraph (3) applies, the Health Authority shall inform the Medical Practices Committee of the condition of practice that it has selected.
Report by Health Authority to Medical Practices Committee
14.A Health Authority shall, at least once in every three years, make a report to the Medical Practices Committee containing the information set out in Part II of Schedule 3, to enable the Medical Practices Committee to judge the adequacy of the provision of general medical services in the area or its different localities.
Variation and revocation of decisions of the Medical Practices Committee
15. - (1) Subject to paragraph (2), on an application by a Health Authority which made the original reference pursuant to regulation 11(1), the Medical Practices Committee may -
(a) (except in cases where an additional doctor has already been nominated or approved pursuant to regulation 18A, 18B or 18C), revoke a decision made pursuant to regulation 13(1) to declare a vacancy for an additional doctor in a locality;
(b) in the case of a condition imposed pursuant to regulation 13(1)(b) (or such a condition as varied pursuant to this regulation) -
(i) vary the condition by imposing in relation to any doctor who fills or would fill that particular vacancy such other condition set out in regulation 13(2)(a) to (e) as has been requested in the application, or
(ii) specify as alternatives two or more of the conditions set out in regulation 13(2)(a) to (d), in which case the Health Authority shall select which of those alternatives is to be imposed on any doctor who fills or would fill that particular vacancy and shall inform the Medical Practices Committee of the condition so selected;
(c) in the case of a condition imposed pursuant to regulation 13(1)(c) (or such a condition as varied pursuant to this regulation), revoke the condition, or vary it by specifying such other part of the locality in which the doctor is to be excluded from providing general medical services as the Committee considers appropriate; or
(d) refuse to vary or revoke the decision in question.
(2) The Health Authority may not make an application for any decision referred to in paragraph (1)(b) or (c) without the written consent of any doctor to whom the existing condition applies.
(3) An application for the purposes of paragraph (1) shall be made in writing and shall include the following information -
(a) the reasons for the application, including any request as to which condition of practice referred to in regulation 13(1)(b) or (c) the Health Authority wishes the Medical Practices Committee to impose in relation to the doctor who fills, or would fill, the vacancy, and (in the case of an application for a decision referred to in paragraph (1)(b) or (c)) a declaration either that there is no doctor to whom the existing condition applies, or that he has consented in writing to the application;
(b) where regulation 11(4) applied, a declaration that the Health Authority has consulted any other Health Authority (or, where regulation 18J applied, any Health Board) in whose area a doctor's patients are or are expected to be situated and, where the views of that other Authority or Board differ from those of the Health Authority, details of those differing views;
(c) a declaration that the Health Authority has consulted any Local Medical Committee for its area (and that any other Health Authority or Health Board in whose area a doctor's patients are or are expected to be situated has also consulted any Local Medical Committee for its area) and a fair reflection in summarised form of the views of that Committee or, as the case may be, those Committees; and
(d) any other information that the Medical Practices Committee may reasonably require.
(4) Paragraphs (5) and (6) of regulation 12 shall apply in the case of the determination of an application under this regulation as they apply to a determination under that regulation.
(5) In determining an application under this regulation the Medical Practices Committee shall take account of the views of the Health Authority, and of the views of any other Health Authority (or, where regulation 18J applies, any Health Board) and of any Local Medical Committee as set out pursuant to sub-paragraphs (b) and (c) of paragraph (3).
(6) The Medical Practices Committee shall, in all cases, give the Health Authority which made the application a written statement of the reasons for its decision.
(7) In cases where the Health Authority has, at the request or with the consent of a particular doctor, made an application to vary a condition imposed pursuant to regulation 13(1)(b) or vary or revoke a condition imposed pursuant to regulation 13(1)(c) then the Health Authority shall give to that doctor a copy of the written statement referred to in paragraph (6).
Effect of variation or revocation
16.A decision by the Medical Practices Committee under regulation 12, 13 or 15 has effect until it is varied or revoked, or expires by effluxion of time pursuant to regulation 12(4)(c).
Notes:
[1] 1977 c.49; see section 128(1) as amended by the National Health Service and Community Care Act 1990 (c.19) ("the 1990 Act"), section 26(2)(g) and (i), for the definitions of "prescribed" and "regulations". Section 7 was amended by the 1990 Act, section 22, and modified by S.I. 1993/887 and 1994/545. Section 29 was extended by the Health and Medicines Act 1988 (c.49), section 17; and amended by the Health Services Act 1980 (c.53), sections 1 and 7 and Schedule 1, paragraph 42(b); by the Health and Social Services and Social Security Adjudications Act 1983 (c.41), Schedule 6, paragraph 2; by the Medical Act 1983 (c.54), section 56(1) and Schedule 5, paragraph 16(a); by S.I. 1985/39, article 7(3); by the Health Authorities Act 1995 (c.17) ("the 1995 Act"), Schedule 1, paragraph 18; and by the National Health Service (Primary Care) Act 1997 (c.46) ("the 1997 Act"), Schedule 2, paragraph 8. Sections 29A and 29B are inserted (from 10th December 1998) by the 1997 Act, section 32. Section 31 was extended by the 1997 Act, section 11 and amended by S.I. 1985/39, article 7(6); by the 1995 Act, Schedule 1, paragraph 20, and (from 10th December 1998) by the 1997 Act, section 32. Section 34 was amended by S.I. 1985/39, article 7(8); by the 1990 Act, section 23(7); by the 1995 Act, Schedule 1, paragraph 23 and (from 10th December 1998) by the 1997 Act, Schedule 2, paragraph 11. Section 45(1) was amended by the Health and Social Security Act 1984 (c.48), Schedule 3, paragraph 7(a); and by the 1995 Act, Schedule 1, paragraph 33. Section 126(4) was amended by the 1990 Act, section 65(2). Paragraph 1(3) of Schedule 10 was amended by the 1997 Act, Schedule 2, paragraph 30(2).back[2] S.I. 1992/635; relevant amending instruments are S.I. 1994/633, 1995/80, 1995/3093, 1997/2468 and 1998/682.back [3] Regulation 13 is substituted by Schedule 1 to these Regulations.back
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