[Home] [Databases] [World Law] [Multidatabase Search] [Help] [Feedback]
	Statutory Rules of Northern Ireland
You are here: BAILII >> Databases >> Statutory Rules of Northern Ireland >> The Health and Personal Social Services (General Medical Services Contracts) Regulations (Northern Ireland) 2004 No. 140 URL: http://www.bailii.org/nie/legis/num_reg/2004/20040140.html

[New search] [Help]

"approved medical practice" shall be construed in accordance with section 11(4) of the Medical Act 1983[4];

"Article 15B provider" means a person who is providing primary medical services in accordance with Article 15B arrangements[5];

"assessment panel" means a committee or sub-committee of a Board (other than the Board which is a party to the contract in question) appointed to exercise functions under paragraphs 31 and 35 of Schedule 5;

"Board" means, unless the context otherwise requires, the Health and Social Services Board which is a party, or prospective party, to the contract;

"CCT" means Certificate of Completion of Training awarded under Article 8 of the 2003 Order, including any such certificate awarded in pursuance of the competent authority functions of the Postgraduate Medical Education and Training Board specified in Article 20(3)(a) of that Order;

"cervical screening services" means the services described in paragraph 2(2) of Schedule 1;

"charity trustee" means one of the persons having the general control and management of the administration of a charity;

"chemist" means -

(a) a registered pharmacist,

(b) a person lawfully conducting a retail pharmacy business in accordance with section 69 of the Medicines Act 1968[6], or

(c) a supplier of appliances,

who is included in the pharmaceutical list under Article 63 of the Order.

"child health surveillance services" means the services described in paragraph 6(2) of Schedule 1;

"childhood vaccinations and immunisations" means the services described in paragraph 5(2) of Schedule 1;

"closed", in relation to the contractor's list of patients, means closed to applications for inclusion in the list of patients other than from immediate family members of registered patients;

"contraceptive services" means the services described in paragraph 3(2) of Schedule 1;

"contract" means a general medical services contract under Article 57 of the Order;

"contractor's list of patients" means the list prepared and maintained by the Board under paragraph 14 of Schedule 5;

"core hours" means the period beginning at 8am and ending at 6.30pm on any day from, and including, Monday to Friday except a public holiday and a local holiday agreed with the Board;

"dispensing services" means the provision of drugs, medicines or appliances that may be provided by a medical practitioner in accordance with arrangements made under regulation 11 of the Pharmaceutical Regulations;

"disqualified" means local or general disqualification by the Tribunal under paragraph 3(2) of Schedule 11 to the Order[7] (or a decision under provisions in operation in England, Wales or Scotland corresponding to local or general disqualification), but does not include conditional disqualification under paragraph 4 of Schedule 1 to the Order;

"Drug Tariff" means the statement published under regulation 9 of the Pharmaceutical Regulations;

"enhanced services" are -

(a) services other than essential services, additional services or out of hours services; or

(b) essential services, additional services or out of hours services or an element of such a service that a contractor agrees under the contract to provide in accordance with specifications set out in a plan, which requires of the contractor an enhanced level of service provision compared to that which it needs generally to provide in relation to that service or element of service;

"essential services" means the services required to be provided in accordance with regulation 15;

"general medical practitioner" means -

(a) from the coming into operation of Article 10 of the 2003 Order, a medical practitioner whose name is included in the General Practitioner Register otherwise than by virtue of paragraph 1(d) of Schedule 6 to that Order, and

(b) until the coming into operation of that Article, a medical practitioner who is either -


(i) until the coming into operation of paragraph 22 of Schedule 8 to the 2003 Order, suitably experienced within the meaning of Article 8(2) of the Health and Personal Social Services (Northern Ireland) Order 1978[8], section 31(2) of the National Health Service Act 1977[9] or section 21 of the National Health Service (Scotland) Act 1978[10]; or

(ii) upon the coming into operation of paragraph 22 of Schedule 8 to the 2003 Order, an eligible general practitioner pursuant to that paragraph other than by virtue of having an acquired right under paragraph 1(d) of Schedule 6 to the 2003 Order;

"General Practitioner Register" means the register kept by the General Medical Council under Article 10 of the 2003 Order;

"global sum" has the same meaning as in the Statement of Financial Entitlements;

"GP Registrar" -

(a) until the coming into operation of Article 5 of the 2003 Order, means a medical practitioner who is being trained in general practice by a medical practitioner who -


(i) has been approved for that purpose by the Joint Committee on Postgraduate Training for General Practice under regulation 7 of the Medical Practitioners (Vocational Training ) Regulations (Northern Ireland) 1998[11], and

(ii) performs primary medical services, and



(b) from the coming into operation of that Article, means a medical practitioner who is being trained in general practice by a GP Trainer whether as part of training leading to the award of a CCT or otherwise;

"GP Trainer" means a general medical practitioner who is -

(a) until the coming into operation of Article 4(5)(d) of the 2003 Order, approved as a GP Trainer by the Joint Committee on Postgraduate Training for General Practice under regulation 7 of the Medical Practitioners (Vocational Training) Regulations (Northern Ireland) 1998; or

(b) from the coming into operation of that Article, approved by the Postgraduate Medical Education and Training Board under Article 4(5)(d) of the 2003 Order for the purposes of providing training to a GP Registrar under Article 5(1)(c)(i);

"Health Board" means a Health Board established under section 2 of the National Health Service (Scotland) Act 1978[12];

"health services body" means -

(a) any person or body referred to in Article 8(2) of the 1991 Order;

(b) persons entering into a contract who are to be regarded as a health services body in accordance with regulation 10 (health services body status);

"HSS contract" has the meaning assigned to it by Article 8 of the 1991 Order;

"immediate family member" means -

(a) a spouse,

(b) a person (whether or not of the opposite sex) whose relationship with the registered patient has the characteristics of the relationship between husband and wife,

(c) a parent or step-parent,

(d) a son,

(e) a daughter,

(f) a child of whom the registered patient is -


(i) the guardian, or

(ii) the person with whom the child has been placed by an authority under Article 27(2) of the Children (Northern Ireland) Order 1995[13], or



(g) a grandparent;

"independent nurse prescriber" means a person -

(a) who is either engaged or employed by the contractor or is a party to the contract,

(b) who is registered in the Nursing and Midwifery Register, and -

(c) in respect of whom an annotation signifying that he is qualified to order drugs, medicines and appliances from -


(i) the Nurse Prescribers' Formulary for District Nurses and Health Visitors in Part XVIIB(i) of the Drug Tariff, or

(ii) the Nurse Prescribers' Extended Formulary in Part XVIIB(ii) of the Drug Tariff,



is also recorded in that register;

"licensing authority" shall be construed in accordance with section 6(3) of the Medicines Act 1968[14];

"licensing body" means any body that licenses or regulates any profession;

"limited partnership" means a partnership registered in accordance with section 5 of the Limited Partnerships Act 1907[15];

"Local Health Board" means a body established under section 16BA of the National Health Services Act 1977[16];

"Local Medical Committee" means the committee of that name recognised by a Board under Article 55B of the Order[17](Local medical committees) ;

"maternity medical services" means the services described in paragraph 7 of Schedule 1;

"medical card" means a card issued by the Agency, a Primary Care Trust, Local Health Board, Health Authority or Health Board to a person for the purpose of enabling him to obtain, or establishing his title to receive, primary medical services;

"medical officer" means a medical practitioner who is -

(a) employed or engaged by the Department for Social Development, or

(b) provided by an organisation in pursuance of a contract entered into with the Department for Social Development;

"Medical Register" means the registers kept under section 2 of the Medical Act 1983[18];

"minor surgery" means the services described in paragraph 8(2) of Schedule 1;

"national disqualification" means a general disqualification by the Tribunal under paragraph 3(2)(b) of Schedule 11 to the Order or a decision under corresponding provisions in operation in England, Wales or Scotland;

"the dispute resolution procedure" means the procedure for resolution of disputes specified -

(a) in paragraphs 92 and 93 of Schedule 5; or

(b) in a case to which paragraph 36 of Schedule 5 applies, in that paragraph.

"normal hours" means those days and hours on which and the times at which services under the contract are normally made available and may be different for different services;

"the Northern Ireland Commissioner for Complaints" means the person appointed under section 36(1) of the Northern Ireland Constitution Act 1973[19];

"NHS Foundation Trust" shall be construed in accordance with Part 1 of the Health and Social Care (Community Health and Standards) Act 2003[20];

"NHS Trust" means a trust established under Part 1 of the National Health Service and Community Care Act 1990[21];

"Nursing and Midwifery Register" means the register maintained by the Nursing and Midwifery Council under to the Nursing and Midwifery Order 2001[22];

"open", in relation to a contractor's list of patients, means open to applications from patients in accordance with paragraph 15 of Schedule 5;

"the Order" means the Health and Personal Social Services (Northern Ireland) Order 1972;

"the 1991 Order" means the Health and Personal Social Services (Northern Ireland) Order 1991;

"the 2003 Order" means the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003[23];

"out of hours period" means -

(a) the period beginning at 6.30pm on any day from, and including, Monday to Thursday and ending at 8am on the following day;

(b) the period between 6.30pm on, and including, Friday and 8am on the following Monday; and

(c) any public holiday or local holiday agreed with the Board,

and "part" of an out of hours period means any part of any one or more of the periods described in paragraphs (a) to (c);

"out of hours services" means services required to be provided in all or part of the out of hours period which -

(a) would be essential services if provided in core hours, or

(b) are included in the contract as additional services funded under the global sum;

"patient" means -

(a) registered patient,

(b) a temporary resident,

(c) persons to whom the contractor is required to provide immediately necessary or necessary treatment under regulation 15(6) or (8) respectively,

(d) any other person to whom the contractor has agreed to provide services under the contract, and

(e) any person for whom the contractor is responsible under regulation 31;

"Pharmaceutical Regulations" means the Pharmaceutical Services Regulations (Northern Ireland) 1997[24];

"the POM Order" means the Prescription Only Medicines (Human Use) Order 1997[25];

"practice" means the business operated by the contractor for the purpose of delivering services under the contract;

"practice area" means the area referred to in regulation 18(1)(d);

"practice leaflet" means a leaflet drawn up in accordance with paragraph 71 of Schedule 5;

"practice premises" means an address specified in the contract as one at which services are to be provided under the contract;

"prescriber" means -

(a) a medical practitioner,

(b) an independent nurse prescriber, and

(c) a supplementary prescriber,

who is either engaged or employed by the contractor or is a party to the contract;

"prescription form" means a form provided by the Agency and issued by a prescriber to enable a person to obtain pharmaceutical services;

"prescription only medicine" means a medicine referred to in Article 3 of the POM Order (medicinal products on prescription only);

"primary medical services performers list" means the list of persons performing primary medical services prepared in accordance with regulations made under Article 57G of the Order[26] (persons performing primary medical services);

"primary carer" means, in relation to an adult the person primarily caring for him;

"Primary Care Trust" means a Primary Care Trust established under section 16A of the National Health Service Act 1977(c);

"registered nursing home" means a nursing home in respect of which a person is registered under Part III of the Registered Homes (Northern Ireland) 1992[27];

"registered patient" means -

(a) a person who is recorded by the Board as being on the contractor's list of patients, or

(b) a person whom the contractor has accepted for inclusion on his list of patients, whether or not notification of that acceptance has been received by the Board and who has not been notified by the Board as having ceased to be on that list;

"relevant register" means -

(a) in relation to a nurse, the Nursing and Midwifery Register; and

(b) in relation to a pharmacist, the register maintained in pursuance of section 2(1) of the Pharmacy Act 1954[28] or the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976[29];

"restricted availability appliance" means an appliance which is approved for particular categories of persons or particular purposes only;

"Statement of Financial Entitlements" means the directions given by the Department under Article 57C of the Order[30];

"Strategic Health Authority" means an authority established under section 8 of the National Health Services Act 1977[31];

"Scheduled drug" means -

(a) a drug, medicine or other substance specified in any directions given by the Department under Article 57D of the Order[32] as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract, or

(b) except where the conditions in paragraph 40(2) of Schedule 5 are satisfied, a drug, medicine or other substance which is specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which can only be ordered for specified patients and specified purposes;

"supplementary prescriber" means a person -

(a) who is either engaged or employed by the contractor or is a party to the contract,

(b) whose name is registered in -


(i) Parts 1, 3, 5, 8, 10, 11, 12, 13, 14 or 15 of the Nursing and Midwifery Register,

(ii) the Register of Pharmaceutical Chemists maintained in pursuance of section 2(1) of the Pharmacy Act 1954, or

(iii) the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976, and



(c) against whose name is recorded in the relevant register an annotation signifying that he is qualified to order drugs, medicines and appliances as a supplementary prescriber;

"temporary resident" means a person accepted by the contractor as a temporary resident under paragraph 16 of Schedule 5 and for whom the contractor's responsibility has not been terminated in accordance with that paragraph;

"the Tribunal" means the body constituted under Schedule 11 to the Order[33];

"working day" means any day apart from Saturday, Sunday, a public holiday or a local holiday agreed with the Board;

"writing", except in paragraph 96(1) of Schedule 5, includes electronic mail and "written" shall be construed accordingly.

General condition relating to all contracts
     5.  - (1) It is a condition in the case of a contract to be entered into -

(a) with a medical practitioner, that the medical practitioner;

(b) with two or more individuals practising in partnership, that any individual or the partnership; and

(c) with a company limited by shares that -


(i) the company,

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

(iii) any director or secretary of the company,



must not fall within paragraph (2).

    (2) A person falls within this paragraph if -

(a) he is the subject of a national disqualification;

(b) subject to paragraph (3), he is disqualified or suspended (other than by an interim suspension order or direction pending an investigation) from practising by any licensing body anywhere in the world;

(c) within the period of five years prior to the signing of the contract or commencement of the contract, whichever is the earlier, he has been dismissed (otherwise than by reason of redundancy) from any employment by a health services body unless he has subsequently been employed by that health services body or another health services body and paragraph (4) applies to him, or that dismissal was the subject of a finding of unfair dismissal by any competent tribunal or court;

(d) within the period of five years prior to signing the contract or commencement of the contract, whichever is the earlier, he has been disqualified from a primary medical service performers list unless his name has subsequently been included in such a list;

(e) he has been convicted in the United Kingdom of murder;

(f) he has been convicted in the United Kingdom of a criminal offence other than murder, committed on or after 1st April 2004, and has been sentenced to a term of imprisonment of over six months;

(g) subject to paragraph (5) he has been convicted elsewhere of an offence -


(i) which would if committed in Northern Ireland constitute murder; or

(ii) committed on or after 1st April 2004, which would if committed in Northern Ireland constitute a criminal offence other than murder, and been sentenced to a term of imprisonment of over six months;



(h) he has been convicted of an offence referred to in Schedule 1 to the Children and Young Persons Act (Northern Ireland) 1968[35], Schedule 1 to the Children and Young Persons Act 1933[36] (offences against children and young persons with respect to which special provisions of this Act apply) or Schedule 1 to the Criminal Procedure (Scotland) Act 1955 (offences against children under the age of 17 years to which special provisions apply)[37], committed on or after 29th March 2004;

(i) he has -



(i) been adjudged bankrupt or had sequestration of his estate awarded unless (in either case) he has been discharged or the bankruptcy order has been annulled;

(ii) been made the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986[38] unless that order has ceased to have effect or has been annulled, or

(iii) made a composition or arrangement with, or granted a trust deed for, his creditors unless he has been discharged in respect of it;



(j) an administrator, administrative receiver or receiver is appointed in respect of him;

(k) he has been -



(i) removed from the office of charity trustee or trustee for a charity by an order made by the Charity Commissioners or the High Court on the grounds of any misconduct or mismanagement in the administration of the charity for which he was responsible or to which he was privy, or which he by his conduct contributed to or facilitated; or

(ii) removed under section 7 of the Law Reform (Miscellaneous Provisions) (Scotland) Act 1990[39] (powers of the Court of Session to deal with management of charities), from being concerned in the management or control of any body; or



(l) he is subject to a disqualification order under the Companies Directors Disqualification (Northern Ireland) Order 2002[40], the Company Directors Disqualification Act 1986[41], or to an order made under section 429(2)(b) of the Insolvency Act 1986 (failure to pay under county court administration order).

    (3) A person shall not fall within paragraph (2)(b) where the Board is satisfied that the disqualification or suspension from practising is imposed by a licensing body outside the United Kingdom and it does not make the person unsuitable to be -

(a) a contractor;

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

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


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

(ii) a director or secretary of the company,



as the case may be.

    (4) Where a person has been employed as a member of a health care profession any subsequent employment must also be as a member of that profession.

    (5) A person shall not fall within paragraph (2)(g) where the 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 individuals practising in partnership;

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


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

(ii) a director or secretary of the company,



as the case may be.

Reasons
     6.  - (1) Where a Board is of the view that the conditions in regulation 4 or 5 for entering into a contract are not met it shall notify in writing the person intending to enter into the contract of its view and of its reasons for that view and of his right of appeal under regulation 7.

    (2) The Board shall also notify in writing of its view and its reasons for that view any person legally and beneficially owning a share in, or a director or secretary of, a company that is notified under paragraph (1) where its reason for the decision relates to that person or persons.

Appeal
     7. A person who has been served with a notice under regulation 6(1) may appeal to the Department against the decision of the Board by giving notice in writing to the Department within the period of 28 days beginning on the day that the Board served its notice.

Prescribed period under Article 15C(b)(iii) of the Order
     8. The period prescribed for the purposes of Article 15C(1)(b)(iii) of the Order (persons with whom agreements may be made)[42] is six months.

Health and social services contract
     12. If the contractor is to be regarded as a health services body pursuant to regulation 10, the contract must state that it is an HSS contract.

Contracts with individuals practising in partnership
     13.  - (1) Where the contract is with two or more individuals practising in partnership, the contract shall be treated as made with the partnership as it is from time to time constituted, and the contract shall make specific provision to this effect.

    (2) Where the contract is with two or more individuals practising in partnership, the contractor must be required by the terms of the contract to ensure that any person who becomes a member of the partnership after the contract has come into operation is bound automatically by the contract whether by virtue of a partnership deed or otherwise.

Duration
     14.  - (1) Except in the circumstances specified in paragraph (2), a contract must provide for it to subsist until it is terminated in accordance with the terms of the contract or the general law.

    (2) The circumstances referred to in paragraph (1) are that the Board wishes to enter into a temporary contract for a period not exceeding twelve months for the provision of services to the former patients of a contractor, following the termination of that contractor's contract.

    (3) Either party to a prospective contract to which paragraph (2) applies may, if it wishes to do so, invite the Local Medical Committee for the area of the Board to participate in the negotiations intending to lead to such a contract.

Essential services
     15.  - (1) For the purposes of Article 57A of the Order (requirement to provide certain primary medical services), the services which must be provided under a general medical services contract ("essential services") are the services described in paragraphs (3), (5), (6) and (8).

    (2) Subject to regulation 20, a contractor must provide the services described in paragraphs (3) and (5) throughout the core hours.

    (3) The services described in this paragraph are services required for the management of his registered patients and temporary residents who are, or believe themselves to be -

(a) ill, with conditions from which recovery is generally expected;

(b) terminally ill; or

(c) suffering from chronic disease,

delivered in the manner determined by the practice in discussion with the patient.

    (4) For the purposes of paragraph (3) -

"disease" means a disease included in the list of three-character categories contained in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems[43]; and

"management" includes -

(a) offering consultation and, where appropriate, physical examination for the purpose of identifying the need, if any, for treatment or further investigation; and

(b) the making available of such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the Order and liaison with other health care professionals involved in the patient's treatment and care.

    (5) The services described in this paragraph are the provision of appropriate ongoing treatment and care to all registered patients and temporary residents taking account of their specific needs including -

(a) the provision of advice in connection with the patient's health, including relevant health promotion advice; and

(b) the referral of the patient for other services under the Order.

    (6) A contractor must provide primary medical services required in core hours for the immediately necessary treatment of any person to whom the contractor has been requested to provide treatment owing to an accident or emergency at any place in his practice area.

    (7) In paragraph (6), "emergency" includes any medical emergency whether or not related to services provided under the contract.

    (8) A contractor must provide primary medical services required in core hours for the immediately necessary treatment of any person falling within paragraph (9) who requests such treatment, for the period specified in paragraph (10).

    (9) A person falls within paragraph (8) if he is a person -

(a) whose application for inclusion in the contractor's list of patients has been refused in accordance with paragraph 17 of Schedule 5 and who is not registered with another provider of essential services (or their equivalent) in the area of the Board;

(b) whose application for acceptance as a temporary resident has been rejected under paragraph 17 of Schedule 5; or

(c) who is present in the contractor's practice area for less than 24 hours.

    (10) The period referred to in paragraph (8) is -

(a) in the case of paragraph (9)(a), 14 days beginning with and including the date on which that person's application was rejected (or, as the case may be, with and including the date on which the contractor requested the removal of that person from his list of patients) or until that person has been subsequently registered elsewhere for the provision of essential services (or their equivalent), whichever occurs first;

(b) in the case of paragraph (9)(b), 14 days beginning with and including the date on which that person's application was rejected or until that person has been subsequently accepted elsewhere as a temporary resident, whichever occurs first; and

(c) in the case of paragraph (9)(c), 24 hours or such shorter period as the person is present in the contractor's practice area.

Additional services
     16. A contract which includes the provision of any additional services must -

(a) in relation to all such services as are included in the contract, contain a term which has the same effect as that specified in paragraph 1 of Schedule 1; and

(b) in relation to each such service as is included in the contract, contain terms which have the same effect as those specified in Schedule 1 which are relevant to that service.

Opt outs of additional and out of hours services
     17.  - (1) Where a contract provides for the contractor to provide an additional service that is to be funded through the global sum the contract must contain terms relating to the procedure for opting out of additional services which have the same effect as those specified in paragraphs 1, 2, 3 and 6 of Schedule 3 except paragraph 3(12) to (14).

    (2) Where a contract which is entered into before 1st October 2004 provides for the contractor to provide out of hours services pursuant to regulation 30 or 31, the contract must contain terms relating to the procedure for opting out of those services which have the same effect as those specified in paragraphs 4, 5 and 6 of Schedule 3 except paragraphs 4(9) and 5(17) in so far as those paragraphs relate to paragraph 3(12) to (14).

    (3) Where a contract which is entered into on or after 1st October 2004 provides for the contractor to provide out of hours services pursuant to regulation 29, the contract must contain terms relating to the procedure for opting out of those services which have the same effect as those specified in paragraphs 4 and 6 of Schedule 2 except paragraph 4(9) in so far as those paragraphs relate to paragraph 3(12) to (14).

    (4) Paragraph 3(12) to (14) and paragraphs 4(9) and 5(17) in so far are those paragraphs relate to paragraph 3(12) to (14) of Schedule 2 shall have effect in relation to the matters set out in those paragraphs.

Services generally
     18.  - (1) A contract must specify -

(a) the services to be provided;

(b) subject to paragraph (2), the address of each of the premises to be used by the contractor or any sub-contractor for the provision of such services;

(c) to whom such services are to be provided;

(d) the area as respects which persons resident in it will, subject to any other terms of the contract relating to patient registration, be entitled to -


(i) register with the contractor, or

(ii) seek acceptance by the contractor as a temporary resident; and



(e) whether, at the date on which the contract comes into operation, the contractor's list of patients is open or closed.

    (2) The premises referred to in paragraph (1)(b) do not include -

(a) the homes of patients; or

(b) any other premises where services are provided on an emergency basis.

    (3) Where, on the date on which the contract is signed, the Board is not satisfied that all or any of the premises specified in accordance with paragraph (1)(b) meet the requirements set out in paragraph 1 of Schedule 5, the contract must include a plan, drawn up jointly by the Board and the contractor, which specifies -

(a) the steps to be taken by the contractor to bring the premises up to the relevant standard;

(b) any financial support that may be available from the Board; and

(c) the timescale on which the steps referred to in sub-paragraph (a) will be taken.

    (4) Where, in accordance with paragraph (1)(e), the contract specifies that the contractor's list of patients is closed it must also specify in relation to that closure each of the items listed in paragraph 29(8)(a) to (d) of Schedule 5.

     19.  - (1) Except in the case of the services referred to in paragraph (2), the contract must state the period (if any) for which the services are to be provided.

    (2) The services referred to in paragraph (1) are -

(a) essential services;

(b) additional services funded under the global sum; and

(c) out of hours services provided pursuant to regulations 30 and 31.

     20. A contract must contain a term which requires the contractor in core hours-

(a) to provide -


(i) essential services, and

(ii) additional services funded under the global sum,



at such times, within core hours, as are appropriate to meet the reasonable needs of his patients; and

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

Certificates
     21.  - (1) A contract must contain a term which has the effect of requiring the contractor to issue free of charge to a patient or his personal representatives any medical certificate of a description prescribed in column 1 of Schedule 3, which is reasonably required under or for the purposes of the statutory provisions specified in relation to the certificate in column 2 of that Schedule, except where, for the condition to which the certificate relates, the patient -

(a) is being attended by a medical practitioner who is not -


(i) employed or engaged by the contractor;

(ii) in the case of a contract with two or more individuals practising in partnership, one of those individuals; or

(iii) in the case of a contract with a company limited by shares, one of the persons legally or beneficially owning shares in that company; or



(b) is not being treated by or under the supervision of a health care professional.

    (2) The exception in paragraph (1)(a) shall not apply where the certificate is issued pursuant to regulation 2(1)(b) of the Social Security (Medical Evidence) Regulations (Northern Ireland) 1976[44] (which provides for the issue of a certificate in the form of a special statement by a doctor on the basis of a written report made by another doctor).

Finance
     22  - (1) Subject to paragraph (2), the contract must contain a term which has the effect of requiring the Board to make payments to the contractor under the contract promptly and in accordance with both the terms of the contract and any other conditions relating to the payment contained in directions given by the Department under Article 57C of the Order[45].

    (2) The obligation referred to in paragraph (1) is subject to any right the Board may have to set off against any amount payable to the contractor under the contract any amount -

(a) that is owed by the contractor to the Board under the contract; or

(b) that the Board may withhold from the contractor in accordance with the terms of the contract or any other applicable provisions contained in directions given by the Department under Article 57C of the Order.

     23. The contract must contain a term to the effect that where, pursuant to directions under Article 57C of the Order, a Board is required to make a payment to a contractor under a contract but subject to conditions, those conditions are to be a term of the contract.

Fees and charges
     24.  - (1) The contract must contain terms relating to fees and charges which have the same effect as those set out in paragraphs (2) to (4).

    (2) The contractor shall not, either himself or through any other person, demand or accept from any patient of his a fee or other remuneration, for his own or another's benefit, for -

(a) provision of any treatment whether under the contract or otherwise; or

(b) any prescription for any drug, medicine or appliance,

except in the circumstances set out in Schedule 4.

    (3) Where a person applies to a contractor for the provision of essential services and claims to be on that contractor's list of patients, but fails to produce his medical card on request and the contractor has reasonable doubts about that person's claim, the contractor shall give any necessary treatment and shall be entitled to demand and accept a reasonable fee in accordance with paragraph (e) of Schedule 4, subject to the provision for repayment contained in paragraph (4).

    (4) Where a person from whom a contractor received a fee under paragraph (e) of Schedule 4 applies to the Board for a refund within 14 days of payment of the fee (or such longer period not exceeding a month as the Board may allow if it is satisfied that the failure to apply within 14 days was reasonable) and the Board is satisfied that the person was on the contractor's list of patients when the treatment was given, the Board may recover the amount of the fee from the contractor, by deduction from his remuneration or otherwise, and shall pay that amount to the person who paid the fee.

Arrangements on termination
     25. A contract shall make suitable provision for arrangements on termination of a contract, including the consequences (whether financial or otherwise) of the contract ending.

Other contractual terms
     26.  - (1) A contract must, unless it is of a type or nature to which a particular provision does not apply, contain other terms which have the same effect as those specified in Schedule 5 except paragraphs 31(6) to (8), 35(5) to (9), 36(5) to (17), 93(5) to (14) and 94.

    (2) The paragraphs specified in paragraph (1) shall have effect in relation to the matters set out in those paragraphs.

(a) the consideration of any complaint made to it by any medical practitioner against a medical practitioner specified in paragraph (2) providing services under a contract in the relevant area involving any question of the efficiency of those services;

(b) the reporting of the outcome of the consideration of such complaint to the Board with whom the contract is held in cases where that consideration gives rise to any concerns relating to the efficiency of services provided under a contract;

(c) the making of arrangements for the medical examination of a medical practitioner specified in paragraph (2), where the contractor or the Board is concerned that the medical practitioner is incapable of adequately providing services under the contract and it so requests with the agreement of the medical practitioner concerned; and

(d) the consideration of the report of any medical examination arranged in accordance with sub-paragraph (c) and the making of a written report as to the capability of the medical practitioner of adequately providing services under the contract to the medical practitioner concerned, the contractor and the Board with whom the contractor holds a contract.

    (2) The medical practitioner referred to in paragraph (1)(a) and (c) is a medical practitioner who is -

(a) a contractor;

(b) one of two or more individuals practising in partnership who hold a contract; or

(c) a legal and beneficial shareholder in a company which holds a contract.

    (3) In this regulation, "the relevant area" means the area for which the Local Medical Committee is formed.

    (3) This regulation applies only to contracts under which services are to be provided from 1st April 2004.

Out of hours services
     30.  - (1) Subject to paragraph 10 of Schedule 5, a contract under which services are to be provided before 1st January 2005 (whether or not such services will be provided after that date) must provide for the services specified in paragraph (2) to be provided throughout the out of hours period unless -

(a) the Board has accepted in writing, prior to the signing of the contract, a written request from the contractor that the contract should not require the contractor to make such provision;

(b) the contract is, at the date on which it is signed, with -


(i) a medical practitioner who, on or before 31st March 2004, made an arrangement to transfer his obligations under the terms of service to another medical practitioner under paragraph 20(2) of Schedule 2 to the General Medical Services Regulations (Northern Ireland) 1997[47],

(ii) a partnership in which all of the partners who are general medical practitioners have made arrangements on or before 31st March 2004 to transfer their obligations under the terms of service to other medical practitioners under that paragraph, or

(iii) a company in which all of the general medical practitioners who own shares in that company have on or before 31st March 2004 made arrangements to transfer their obligations under the terms of service to other medical practitioners under that paragraph ;



(c) the contractor has opted out in accordance with paragraph 4 or 5 of Schedule 2; or

(d) the contract has been otherwise varied to exclude a requirement to make such provision.

    (2) The services referred to in paragraph (1) are -

(a) the services which must be provided in core hours under regulation 15; and

(b) such additional services as are included in the contract pursuant to regulation 29.

     31.  - (1) Where the contract is with -

(a) an individual medical practitioner who is, or was on 31st March 2004, responsible for providing services during all or part of the out of hours period to the patients of a medical practitioner who meets the requirements in paragraph (2);

(b) two or more individuals practising in partnership at least one of whom is, or was on 31st March 2004, a medical practitioner responsible for providing such services; or

(c) a company in which one or more of the shareholders is, or was on 31st March 2004, a medical practitioner responsible for providing such services,

the contract with that contractor must require the contractor to continue to provide such services to the patients of the exempt contractor until the happening of one of the events in paragraph (3).

    (2) The requirements referred to in paragraph (1)(a) are that -

(a) the medical practitioner had made an arrangement to transfer his obligations under the terms of service to another medical practitioner under paragraph 20(2) of Schedule 2 to the General Medical Services Regulations (Northern Ireland) 1997; and

(b) he -


(i) has entered or intends to enter into a contract which does not include out of hours services pursuant to regulation 30(1)(b)(i),

(ii) is one of two or more individuals practising in partnership who have entered or intends to enter into a contract which does not include out of hours services pursuant to regulation 30(1)(b) (ii), or

(iii) is the owner of shares in a company which has entered or intends to enter into a contract which does not include out of hours services pursuant to regulation 30(1)(b) (iii).

    (3) The events referred to in paragraph (1) are -

(a) the contractor has opted out of the provision of out of hours services in accordance with paragraph 4 or 5 of Schedule 2; or

(b) the Board (and, if it is different, the Board with whom the exempt contractor holds his contract) has or have agreed in writing that the contractor need no longer provide some or all of those services to some or all of those patients.

    (4) In this regulation "exempt contractor" means a contractor who is exempt from providing out of hours services pursuant to regulation 30(1)(b).

     32. A contract which includes the provision of out of hours services pursuant to regulation 30 or 31 must contain terms which have the same effect as those set out in Schedule 6.



Sealed with the Official Seal of the Department of Health, Social Services and Public Safety on


29th March 2004.

L.S.

Dr. J. F. Livingstone
Senior Officer of the Department of Health, Social Services and Public Safety


Sealed with the Official Seal of the Department of Finance and Personnel on



29th March 2004.

L.S.

C. Doran
Senior Officer of the Department of Finance and Personnel

    (3) The records referred to in sub-paragraph (1)(b) are an accurate record of the carrying out of a cervical screening test, the result of the test and any clinical follow up requirements.

Contraceptive services
     3.  - (1) A contractor whose contract includes the provision of contraceptive services shall make available to all his patients who request such services the services described in sub-paragraph (2).

    (2) The services referred to in sub-paragraph (1) are -

(a) the giving of advice about the full range of contraceptive methods;

(b) where appropriate, the medical examination of patients seeking such advice;

(c) the treatment of such patients for contraceptive purposes and the prescribing of contraceptive substances and appliances (excluding the fitting and implanting of intrauterine devices and implants);

(d) the giving of advice about emergency contraception and where appropriate, the supplying or prescribing of emergency hormonal contraception or, where the contractor has a conscientious objection to emergency contraception, prompt referral to another provider of primary medical services who does not have such conscientious objections;

(e) the provision of advice in cases of unplanned or unwanted pregnancy, including advice about the availability of free pregnancy testing in the practice area and, where appropriate, where the contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services who does not have such conscientious objections;

(f) the giving of initial advice about sexual health promotion and sexually transmitted infections; and

(g) the referral as necessary for specialist sexual health services, including tests for sexually transmitted infections.

Vaccinations and immunisations
     4.  - (1) A contractor whose contract includes the provision of vaccinations and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

    (2) The contractor shall -

(a) offer to provide to patients all vaccinations and immunisations (excluding childhood vaccinations and immunisations) of a type and in the circumstances for which a fee was provided for under the 2003-04 Statement of Fees and Allowances made under regulation 37 of the General Medical Services Regulations (Northern Ireland) 1997[48] other than influenza vaccination;

(b) provide appropriate information and advice to patients about such vaccinations and immunisations;

(c) record in the patient's record kept in accordance with paragraph 68 of Schedule 5 any refusal of the offer referred to in head (a);

(d) where the offer is accepted, administer the vaccinations and immunisations and include in the patient's record kept in accordance with paragraph 68 of Schedule 5 -


(i) the patient's consent to the vaccination or immunisation or the name of the person who gave consent to the vaccination or immunisation and his relationship to the patient,

(ii) the batch numbers, expiry date and title of the vaccine,

(iii) the date of administration,

(iv) in a case where two vaccines are administered in close succession, the route of administration and the injection site of each vaccine,

(v) any contraindications to the vaccination or immunisation, and

(vi) any adverse reactions to the vaccination or immunisation.

    (3) The contractor shall ensure that all staff involved in administering vaccines are trained in the recognition and initial treatment of anaphylaxis.

Childhood vaccinations and immunisations
     5.  - (1) A contractor whose contract includes the provision of childhood vaccinations and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

    (2) The contractor shall -

(a) offer to provide to children all vaccinations and immunisations of a type and in the circumstances for which a fee was provided for under the 2003-04 Statement of Fees and Allowances made under regulation 37 of the General Medical Services Regulations (Northern Ireland) 1997;

(b) provide appropriate information and advice to patients and, where appropriate, their parents, about such vaccinations and immunisations;

(c) record in the patient's record kept in accordance with paragraph 68 of Schedule 5 any refusal of the offer referred to in head (a);

(d) where the offer is accepted, administer the vaccinations and immunisations and include in the patient's record kept in accordance with paragraph 68 of Schedule 5 -


(i) the name of the person who gave consent to the vaccination or immunisation and his relationship to the patient;

(ii) the batch numbers, expiry date and title of the vaccine;

(iii) the date of administration;

(iv) in a case where two vaccines are administered in close succession, the route of administration and the injection site of each vaccine;

(v) any contraindications to the vaccination or immunisation; and

(vi) any adverse reactions to the vaccination or immunisation.

    (3) The contractor shall ensure that all staff involved in administering vaccines are trained in the recognition and initial treatment of anaphylaxis.

Child health surveillance
     6.  - (1) A contractor whose contract includes the provision of child health surveillance services shall, in respect of any child under the age of 5 for whom he has responsibility under the contract -

(a) provide all the services described in sub-paragraph (2), other than any examination so described which the parent refuses to allow the child to undergo, until the date upon which the child attains the age of five years; and

(b) maintain such records as are specified in sub-paragraph (3).

    (2) The services referred to sub-paragraph (1)(a) are -

(a) the monitoring -


(i) by the consideration of any information concerning the child received by or on behalf of the contractor, and

(ii) on any occasion when the child is examined or observed by or on behalf of the contractor (whether pursuant to head (b) or otherwise),



of the health, well-being and physical, mental and social development (all of which characteristics are referred to in this paragraph as "development") of the child while under the age of 5 years with a view to detecting any deviations from normal development;

(b) the examination of the child at a frequency that has been agreed with the Board in accordance with the nationally agreed evidence based programme set out in the fourth edition of "Health for all Children"[49].

    (3) The records mentioned in sub-paragraph (1)(b) are an accurate record of -

(a) the development of the child while under the age of 5 years, compiled as soon as is reasonably practicable following the first examination of that child and, where appropriate, amended following each subsequent examination; and

(b) the responses (if any) to offers made to the child's parent for the child to undergo any examination referred to in sub-paragraph (2)(b).

Maternity medical services
     7.  - (1) A contractor whose contract includes the provision of maternity medical services shall -

(a) provide to female patients who have been diagnosed as pregnant all necessary maternity medical services throughout the ante-natal period;

(b) provide to female patients and their babies all necessary maternity medical services throughout the post-natal period other than neo-natal checks;

(c) provide all necessary maternity medical services to female patients whose pregnancy has terminated as a result of miscarriage or abortion or, where the contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services who does not have such conscientious objections.

    (2) In this regulation -

"ante-natal period" means the period from the start of the pregnancy to the onset of labour;

"maternity medical services" means -

(a) in relation to female patients (other than babies) all primary medical services relating to pregnancy, excluding intra partum care, and

(b) in relation to babies, any primary medical services necessary in their first 14 days of life;

"post-natal period" means the period starting from the conclusion of delivery of the baby or the patient's discharge from secondary care services, whichever is the later, and ending on the fourteenth day after the birth.

Minor surgery
     8.  - (1) A contractor whose contract includes the provision of minor surgery shall comply with the requirements in sub-paragraphs (2) and (3).

    (2) The contractor shall make available to patients where appropriate -

(a) curettage;

(b) cautery; and

(c) cryocautery of warts, verrucae and other skin lesions.

    (3) The contractor shall ensure that his record of any treatment provided under this paragraph includes the consent of the patient to that treatment.

    (7) Where a contractor has given two previous temporary opt out notices within the period of three years ending with the date of the service of the latest opt out notice (whether or not the same additional service is concerned), the latest opt out notice shall be treated as a permanent opt out notice (even if the opt out notice says that he wishes to temporarily opt out).

    (8) Paragraph 2 applies following the giving of a temporary opt out notice and paragraph 3 applies following the giving of a permanent opt out notice or a temporary opt out notice which pursuant to sub-paragraph (7) is treated as a permanent opt out notice.

    (9) No temporary opt out notice may be served by a contractor prior to 1st April 2004.

Temporary opt outs and permanent opt outs following temporary opt outs
     2.  - (1) As soon as is reasonably practicable and in any event within the period of 7 days beginning with and including the date of receipt of a temporary opt out notice under paragraph 1(5), the Board shall -

(a) approve the opt out notice and specify in accordance with sub-paragraphs (3) and (4) the date on which the temporary opt out is to commence and the date that it is to come to an end ("the end date"); or

(b) reject the opt out notice in accordance with sub-paragraph (2),

and shall notify the contractor of its decision as soon as possible, including reasons for its decision.

    (2) A Board may reject the opt out notice on the ground that the contractor -

(a) is providing additional services to patients registered with another contractor or enhanced services; or

(b) has no reasonable need temporarily to opt out having regard to his ability to deliver the additional service.

    (3) The date specified by the Board for the commencement of the temporary opt out shall wherever reasonably practicable be the date requested by the contractor in his opt out notice.

    (4) Before determining the end date, the Board shall make reasonable efforts to reach agreement with the contractor.

    (5) Where the Board approves an opt out notice, the contractor's obligation to provide the additional service specified in the notice shall be suspended from the date specified by the Board in its decision under sub-paragraph (1), and shall remain suspended until the end date unless-

(a) the contractor and the Board agree in writing an earlier date, in which case the suspension shall come to an end on the earlier date agreed;

(b) the Board specifies a later date under sub-paragraph (6), in which case the suspension shall end on the later date specified;

(c) sub-paragraph (7) applies and the contractor refers the matter to the dispute resolution procedure or the court, in which case the suspension shall end-


(i) where the outcome of the dispute is to uphold the decision of the Board, on the day after the date of the decision of the Department or the court,

(ii) where the outcome of the dispute is to overturn the decision of the Board, 28 days after the decision of the Department or the court, or

(iii) where the contractor ceases to pursue the dispute resolution procedure or court proceedings, on the day after the date that the contractor withdraws his claim or the procedure is or proceedings are otherwise terminated by the Department or the court;



(d) sub-paragraph (9) applies and -



(i) the Board refuses the contractor's request for a permanent opt out within the period of 28 days ending with the end date, in which case the suspension shall come to an end 28 days after the end date,

(ii) the Board refuses the contractor's request for a permanent opt out after the end date, in which case the suspension shall come to an end 28 days after the date of service of the opt out notice, or

(iii) the Board notifies the contractor after the end date that the Department has not approved its proposed decision to refuse the contractor's request to permanently opt out under sub-paragraph (14), in which case the suspension shall come to an end 28 days after the date of service of that notice.

    (6) Before the end date, a Board may, in exceptional circumstances and with the agreement of the contractor, notify the contractor in writing of a later date on which the temporary opt out is to come to an end, being a date no more than six months later than the end date.

    (7) Where the Board considers that -

(a) the contractor will be unable to satisfactorily provide the additional service at the end of the temporary opt out; and

(b) it would not be appropriate to exercise its discretion under sub-paragraph (6) to specify a later date on which the temporary opt out is to come to an end or the contractor does not agree to a later date,

the Board may notify the contractor in writing at least 28 days before the end date that a permanent opt out shall follow a temporary opt out.

    (8) Where a Board notifies the contractor under sub-paragraph (7) that a permanent opt out shall follow a temporary opt out, the permanent opt out shall take effect immediately after the end of the temporary opt out.

    (9) A contractor who has temporarily opted out may, at least three months prior to the end date, notify the Board in writing that he wishes to permanently opt out of the additional service in question.

    (10) Where the contractor has notified the Board under sub-paragraph (9) that it wishes to permanently opt out, the temporary opt out shall be followed by a permanent opt out beginning on the day after the end date unless the Board refuses the contractor's request to permanently opt out by giving a notice in writing to the contractor to this effect.

    (11) A Board may only give a notice under sub-paragraph (10) with the approval of the Department.

    (12) Where a Board seeks the approval of the Department to a proposed decision to refuse a permanent opt out, it shall notify the contractor of having done so.

    (13) If the Department has not reached a decision as to whether or not to approve the Board's proposed decision to refuse a permanent opt out before the end date, the contractor's obligation to provide the additional service shall remain suspended until the date specified in sub-paragraph (5)(d)(ii) or (iii) (whichever is applicable).

    (14) Where after the end date the Department notifies the Board that it does not approve the Board's proposed decision to refuse a permanent opt out, the Board shall notify the contractor in writing of this fact as soon as is reasonably practicable.

    (15) A temporary opt out or permanent opt out commences, and a temporary opt out ends, at 08.00 on the relevant day unless the Board and the contractor agree a different day or time.

Permanent opt outs
     3.  - (1) In this paragraph -

"A day" is the day specified by the contactor in his permanent opt out notice to a Board for the commencement of the permanent opt out;

"B day" is the day six months after the date of service of the permanent opt out notice; and

"C day" is the day nine months after the date of service of the permanent opt out notice.

    (2) As soon as is reasonably practicable and in any event within the period of 28 days beginning with and including the date of receipt of a permanent opt out notice under paragraph 1(5) (or temporary opt out notice which is treated as a permanent opt out notice under paragraph 1(7), the Board shall -

(a) approve the opt out notice; or

(b) reject the opt out notice in accordance with sub-paragraph (3),

and shall notify the contractor of its decision as soon as possible, including reasons for its decision where its decision is to reject the opt out notice.

    (3) A Board may reject the opt out notice on the ground that the contractor is providing an additional service to patients other than his registered patients or enhanced services.

    (4) A contractor may not withdraw an opt out notice once it has been approved by the Board in accordance with sub-paragraph (2)(a) without the Board's agreement.

    (5) If the Board approves the opt out notice under sub-paragraph (2)(a), it shall use its reasonable endeavours to make arrangements for the contractor's registered patients to receive the additional service from an alternative provider from A day.

    (6) The contractor's duty to provide the additional service shall terminate on A day unless the Board serves a notice under sub-paragraph (7) (extending A day to B day or C day).

    (7) If the Board is not successful in finding an alternative provider to take on the provision of the additional service from A day, then it shall notify the contractor in writing of this fact no later than one month before A day, and -

(a) in a case where A day is three months after service of the opt out notice, the contractor shall continue to provide the additional service until B day unless at least one month before B day he receives a notice in writing from the Board under sub-paragraph (8) that despite using its reasonable endeavours, it has failed to find an alternative provider to take on the provision of the additional service from B day;

(b) in a case where A day is six months after the service of the opt out notice, the contractor shall continue to provide the additional service until C day unless at least one month before C day he receives a notice from the Board under sub-paragraph (11) that it has made an application to the Department under sub-paragraph (10) seeking its approval to a decision to refuse a permanent opt out or to delay the commencement of a permanent opt out until after C day.

    (8) Where in accordance with sub-paragraph (7)(a) the permanent opt out is to commence on B day and the Board, despite using its reasonable endeavours has failed to find an alternative provider to take on the provision of the additional service from that day, it shall notify the contractor in writing of this fact at least one month before B day, in which case the contractor shall continue to provide the additional service until C Day unless at least one month before C day he receives a notice from the Board under sub-paragraph (11) that it has applied to the Department under sub-paragraph (10) seeking its approval to a decision to refuse a permanent opt out or to postpone the commencement of a permanent opt out until after C day.

    (9) As soon as is reasonably practicable and in any event within 7 days of the Board serving a notice under sub-paragraph (8), the Board shall enter into discussions with the contractor concerning the support that the Board may give to the contractor or other changes which the Board or the contractor may make in relation to the provision of the additional service until C day.

    (10) The Board may, if it considers that there are exceptional circumstances, make an application to the Department for approval of a decision to -

(a) refuse a permanent opt out; or

(b) postpone the commencement of a permanent opt out until after C day.

    (11) As soon as practicable after making an application under sub-paragraph (10) to the Department, the Board shall notify the contractor in writing that it has made such an application.

    (12) On receiving an application under sub-paragraph (10) for approval of a decision to refuse a permanent opt out, the Department shall -

(a) approve the Board's application;

(b) reject the Board's application, but nonetheless recommend a different date for the commencement of the permanent opt out which may be later than C day; or

(c) reject the Board's application.

    (13) On receiving an application under sub-paragraph (10) for approval of a decision to postpone the commencement of a permanent opt out until after C day the Department shall -

(a) approve the Board's application;

(b) reject the Board's application, but nonetheless recommend -


(i) that the permanent opt out commence on an earlier date to that proposed by the Board in its application, or

(ii) that the permanent opt out be refused; or



(c) reject the Board's application.

    (14) The Department shall notify the Board and the contractor in writing of its decision under sub-paragraph (12) or (13) as soon as is practicable, including reasons for its decision.

    (15) Where the Department -

(a) approves a decision to refuse an opt out under sub-paragraph (12)(a); or

(b) recommends that a permanent opt out be refused under sub-paragraph (13)(b)(ii),

the Board shall notify the contractor in writing that the contractor may not opt out of the additional service.

    (16) Where a Board notifies a contractor under sub-paragraph (15), the contractor may not serve a preliminary opt out notice in respect of that additional service for a period of 12 months beginning with the date of service of the Board's notice under sub-paragraph (15) unless there has been a change in the circumstances of the contractor in relation to his ability to deliver services under the contract.

    (17) Where the Department -

(a) recommends a different date for the commencement of the permanent opt out under sub-paragraph (12)(b);

(b) approves a Board's application to postpone a permanent opt out under sub-paragraph (13)(a); or

(c) recommends an earlier date to that proposed by the Board in its application under sub-paragraph (13)(b)(i),

the Board shall in accordance with the decision of the Department notify the contractor in writing of its decision and the notice shall specify the date from which permanent opt out shall commence.

    (18) Where the Department rejects the Board's application under sub-paragraph (12)(c) or (13)(c), the Board shall notify the contractor in writing that there shall be a permanent opt out, and the permanent opt out shall commence on C day or 28 days after the date of service of the Board's notice, whichever is the later.

    (19) If the Department has not reached a decision on the Board's application under sub-paragraph (10) before C day, the contractor's obligation to provide the additional service shall continue until a notice is served on the contractor by the Board under sub-paragraph (17) or (18).

    (20) Nothing in sub-paragraphs (1) to (19) shall prevent the contractor and the Board from agreeing a different date for the termination of the contractor's duty under the contract to provide the additional service and accordingly, varying the contract in accordance with paragraph 96(1) of Schedule 5.

    (21) The permanent opt out takes effect at 08.00 on the relevant day unless the Board and the contractor agree a different day or time.

Out of hours opt outs where the opt out notice is served after 30th September 2004
     4.  - (1) This paragraph applies where a contractor wishes to serve or serves an out of hours opt out notice after 30th September 2004.

    (2) A contractor which wishes to terminate his obligation to provide out of hours services which was included in the contract pursuant to regulation 30 shall notify the Board in writing to that effect ("an out of hours opt out notice").

    (3) An out of hours opt out notice shall specify the date from which the contractor would like the opt out to take effect, which must be either three or six months after the date of service of the out of hours opt out notice.

    (4) As soon as is reasonably practicable and in any event within 28 days of receiving the out of hours opt out notice, the Board shall approve the notice and specify in accordance with sub-paragraph (6) the date on which the out of hours opt out is to commence ("OOH day").

    (5) The Board shall notify the contractor of its decision as soon as possible including the reason for its decision.

    (6) The date specified in sub-paragraph (4) shall be the date specified in the out of hours opt out notice.

    (7) A contractor may not withdraw an out of hours opt out notice once it has been approved by the Board under sub-paragraph (4) without the Board's agreement.

    (8) Following receipt of the out of hours opt out notice, the Board must use its reasonable endeavours to make arrangements for the contractor's registered patients to receive the out of hours services from an alternative provider from OOH day.

    (9) Sub-paragraphs (6) to (21) of paragraph 3 shall apply to an out of hours opt out as they apply to a permanent opt out and as if the reference to "A day" was a reference to "OOH day" and the reference in paragraph 3(16) to a "preliminary opt out notice" was a reference to an out of hours opt out notice.

Out of hours opt outs where the opt out notice is served before 1st October 2004
     5.  - (1) This paragraph shall apply where a contractor wishes to serve or serves an out of hours opt out notice before 1st October 2004.

    (2) In this paragraph -

"OOH day" is the day specified by the Board for the commencement of the out of hours opt out in its decision under sub-paragraph (5);

"OOHB day" is the day six months after the date of service of the out of hours opt out notice; and

"OOHC day" is the day specified by the Board in its decision under sub-paragraph (11) or (13) (which must be nine months after the date of service of the out of hours opt out notice or before 2nd January 2005).

    (3) A contractor which wishes to terminate his obligation to provide out of hours services which was included in the contract pursuant to regulation 30 shall notify the relevant Board in writing to that effect ("an out of hours opt out notice").

    (4) An out of hours opt out notice shall state the date on which the contractor would like the opt out to take effect, which must be either three or six months after the date of service of the out of hours opt out notice.

    (5) As soon as is reasonably practicable and in any event within 28 days of receiving the out of hours opt out notice, the Board shall approve the notice and specify in accordance with sub-paragraphs (6) and (7) the date on which the out of hours opt out is to commence (OOH day) and the Board shall notify the contractor in writing of its decision as soon as possible, including reasons for its decision.

    (6) Subject to sub-paragraph (7), OOH day shall be -

(a) the date specified in the out of hours opt out notice; or

(b) any other date before 2nd January 2005.

    (7) A Board may not specify under sub-paragraph (5) a date earlier than the date specified in the out of hours opt out notice.

    (8) A contractor may not withdraw an out of hours opt out notice once it has been approved by a Board under sub-paragraph (5) without the Board's agreement.

    (9) Following receipt of the out of hours opt out notice, the Board must use its reasonable endeavours to make arrangements for the contractor's registered patients to receive out of hours services from an alternative provider from OOH day.

    (10) The contractor's duty to provide the out of hours services shall terminate on OOH day unless the Board -

(a) serves a notice under sub-paragraph (11) (extending OOH day to OOHB day or OOHC day); or

(b) makes an application under sub-paragraph (14) (seeking the approval of the Department to a decision to refuse an opt out or to delay the taking of effect of an opt out until after OOH day).

    (11) If the Board is not successful in finding an alternative provider to take on the provision of the out hours services from OOH day, then it shall notify the contractor in writing of this fact no later than one month before OOH day, and -

(a) in a case where OOH day is three months after service of the out of hours opt out notice, the contractor shall continue to provide the out of hours services until OOHB day unless at least one month before OOHB day he receives a notice in writing from the Board under sub-paragraph (13) that despite using its reasonable endeavours, it has failed to find an alternative provider to take on the provision of the out of hours services from OOHB day;

(b) in a case where OOH day is after the day three months after the service of the out of hours opt out notice, the contractor shall continue to provide the out of hours services until OOHC day (which shall be specified by the Board in accordance with sub-paragraph (12) and included in its notice to the contractor under this sub-paragraph) unless at least one month before OOHC day he receives a notice from the Board under sub-paragraph (16) that it has made an application to the Department under sub-paragraph (14) seeking the Department's approval to a decision to refuse an opt out or to postpone the commencement of the opt out until after OOHC day.

    (12) OOHC day shall be any day before 2nd January 2005 or the day nine months after the service of the out of hours opt out notice.

    (13) Where in accordance with sub-paragraph (11)(a) the out of hours opt out is to commence on OOHB day and the Board, despite using its reasonable endeavours has failed to find an alternative provider to take on the provision of the out of hours services from that day, it shall notify the contractor in writing of this fact at least one month before OOHB day, in which case the contractor shall continue to provide the out of hours services until OOHC day (which shall be specified by the Board in accordance with sub-paragraph (12) and included in its notice to the contractor under this sub-paragraph) unless at least one month before OOHC day he receives a notice from the Board under sub-paragraph (16) that it has applied to the Department under sub-paragraph (14) seeking the approval of the Department to a decision to refuse an opt out or to postpone the commencement of an opt out until after OOHC day.

    (14) The Board may, if it considers there are exceptional circumstances, make an application to the Department for approval of a decision to -

(a) refuse an opt out; or

(b) postpone the commencement of an opt out until after -


(i) OOHC day, or

(ii) OOH day where OOH day is 1st January 2005 and 1st January 2005 is nine months or more after the date of the out of hours opt out notice.

    (15) Where OOH day is1st January 2005, and 1st January 2005 is nine months or more after the date of the out of hours opt out notice, an application under sub-paragraph (14) shall be made at least one month before OOH day.

    (16) As soon as practicable after making an application under sub-paragraph (14) to the Department, the Board shall notify the contractor in writing that it has made such an application.

    (17) Sub-paragraphs (12) to (21) of paragraph 3 shall apply to an out of hours opt out as they apply to a permanent opt out and as if the reference to "C day" was a reference to OOHC day or OOH day where OOH day is 1st January 2005 and 1st January 2005 is nine months or more after the date of the out of hours opt out notice.

Informing patients of opt outs
     6.  - (1) Prior to any opt out taking effect, the Board and the contractor shall discuss how to inform the contractor's patients of the proposed opt out.

    (2) The contractor shall, if requested by the Board inform his registered patients of an opt out and the arrangements made for them to receive the additional service or out of hours services by -

(a) placing a notice in the practice's waiting room; or

(b) including the information in the practice leaflet.

    (3) In this paragraph "opt out" means an out of hours opt out, a permanent opt out or a temporary opt out.

Attendance at practice premises
     2.  - (1) The contractor shall take steps to ensure that any patient who -

(a) has not previously made an appointment; and

(b) attends at the practice premises during the normal hours for essential services,

is provided with such services by an appropriate health care professional during that surgery period except in the circumstances specified in sub-paragraph (2).

    (2) The circumstances referred to in sub-paragraph (1) are that -

(a) it is more appropriate for the patient to be referred elsewhere for services under the Order; or

(b) the patient is then offered an appointment to attend again within a time which is appropriate and reasonable having regard to all the circumstances and the patient's health would not thereby be jeopardised.

Attendance outside practice premises
     3.  - (1) In the case of a patient whose medical condition is such that in the reasonable opinion of the contractor -

(a) attendance on the patient is required; and

(b) it would be inappropriate for the patient to attend at the practice premises,

the contractor shall provide services to that patient at whichever in his judgement is the most appropriate of the places set out in sub-paragraph (2).

    (2) The places referred to in sub-paragraph (1) are -

(a) the place recorded in the patient's medical records as being his last home address;

(b) such other place as the contractor has informed the patient and the Board is the place where he has agreed to visit and treat the patient; or

(c) some other place in the contractor's practice area.

    (3) Nothing in this paragraph prevents the contractor from -

(a) arranging for the referral of a patient without first seeing the patient, in a case where the medical condition of that patient makes that course of action appropriate; or

(b) visiting the patient in circumstances where this paragraph does not place him under an obligation to do so.

Newly registered patients
     4.  - (1) Where a patient has been -

(a) accepted on a contractor's list of patients under paragraph 15; or

(b) assigned to that list by the Board,

the contractor shall, in addition and without prejudice to his other obligations in respect of that patient under the contract, invite the patient to participate in a consultation either at his practice premises or, if the medical condition of the patient so warrants, at one of the places referred to in paragraph 3(2).

    (2) An invitation under sub-paragraph (1) shall be issued within six months of the date of the acceptance of the patient on, or their assignment to, the contractor's list.

    (3) Where a patient (or, where appropriate, in the case of a patient who is a child, his parent) agrees to participate in a consultation mentioned in sub-paragraph (1) the contractor shall, in the course of that consultation make such inquiries and undertake such examinations as appear to him to be appropriate in all the circumstances.

Patients not seen within three years
     5. Where a registered patient who -

(a) has attained the age of 16 years but has not attained the age of 75 years; and

(b) has attended neither a consultation with, nor a clinic provided by, the contractor within the period of 3 years prior to the date of his request;

requests a consultation the contractor shall, in addition and without prejudice to his other obligations in respect of that patient under the contract, provide such a consultation in the course of which it shall make such inquiries and undertake such examinations as appear to him to be appropriate in all the circumstances.

Patients aged 75 years and over
     6.  - (1) Where a registered patient who -

(a) has attained the age of 75 years; and

(b) has not participated in a consultation under this paragraph within the period of twelve months prior to the date of his request,

requests a consultation, the contractor shall, in addition and without prejudice to his other obligations in respect of that patient under the contract, provide such a consultation in the course of which he shall make such inquiries and undertake such examinations as appear to him to be appropriate in all the circumstances.

    (2) A consultation under sub-paragraph (1) shall take place in the home of the patient where, in the reasonable opinion of the contractor, it would be inappropriate, as a result of the patient's medical condition, for him to attend at the practice premises.

Clinical reports
     7.  - (1) Where the contractor provides any clinical services, other than under a private arrangement, to a patient who is not on his list of patients, he shall, as soon as reasonably practicable, provide a clinical report relating to the consultation, and any treatment provided, to the Board.

    (2) The Board shall send any report received under sub-paragraph (1) -

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

(b) if the person referred to in head (a) is not known to it, to the Board in whose area the patient is resident.

Storage of vaccines
     8. The contractor shall ensure that -

(a) all vaccines are stored in accordance with the manufacturer's instructions,

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

Infection control
     9. The contractor shall ensure that he has appropriate arrangements for infection control and decontamination.

Criteria for out of hours services
     10. A contractor whose contract includes the provision of out of hours services shall only be required to provide such services if, in the reasonable opinion of the contractor in the light of the patient's medical condition, it would not be reasonable in all the circumstances for the patient to wait for the services required until the next time at which he could obtain such services during core hours.

Standards for out of hours services
     11. From 1st January 2005, a contractor which provides out of hours services must in the provision of such services meet any quality standards which have been approved by the Department and specified in writing by the Board in relation to the provision of those services.

Duty of co-operation in relation to additional, enhanced and out of hours services
     12.  - (1) A contractor which does not provide to his registered patients or to persons whom he has accepted as temporary residents -

(a) a particular additional service;

(b) a particular enhanced service; or

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

shall comply with the requirements specified in sub-paragraph (2).

    (2) The requirements referred to in sub-paragraph (1) are that the contractor shall -

(a) co-operate with any person responsible for the provision of that service;

(b) comply in core hours with any reasonable request for information from such a person or from the Board relating to the provision of that service or those services; and

(c) in the case of out of hours services, take reasonable steps to ensure that any patient who contacts the practice premises during the out of hours period is provided with information about how to obtain services during that period.

    (3) Nothing in this paragraph shall require a contractor whose contract does not include the provision of out of hours services to make himself available during the out of hours period.

     13. Where a contractor is to cease to be required to provide to his patients -

(a) a particular additional service;

(b) a particular enhanced service; or

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

he shall comply with any reasonable request for information relating to the provision of that service made by the Board or by any person with whom the Board intends to enter into a contract for the provision of such services.

Application for inclusion in a list of patients
     15.  - (1) The contractor may, if his list of patients is open, accept an application for inclusion in his list of patients made by or on behalf of any person whether or not resident in his practice area or included, at the time of that application, in the list of patients of another contractor or provider of primary medical services.

    (2) The contractor may, if his list of patients is closed, only accept an application for inclusion in his list of patients from a person who is an immediate family member of a registered patient whether or not resident in his practice area or included, at the time of that application, in the list of patients of another contractor or provider of primary medical services.

    (3) Subject to sub-paragraph (4), an application for inclusion in a contractor's list of patients shall be made by delivering to the practice premises a medical card or an application signed (in either case) by the applicant or a person authorised by the applicant to sign on his behalf.

    (4) An application may be made -

(a) on behalf of any child -


(i) by either parent, or in the absence of both parents, the guardian or other adult who has care of the child,

(ii) by a person duly authorised by an authority looking after a child under the provisions of the Children (Northern Ireland) Order 1995, or

(iii) by a person duly authorised by a voluntary organisation by which the child is being accommodated under the provisions of that Order; or



(b) on behalf of any adult who is incapable of making such an application, or authorising such an application to be made on their behalf, by a relative or the primary carer of that person.

    (5) A contractor which accepts an application for inclusion in his list of patients shall notify the Board in writing as soon as possible.

    (6) On receipt of a notice under sub-paragraph (5), the Board shall -

(a) include that person in the contractor's list of patients from the date on which the notice is received; and

(b) notify the applicant (or, in the case of a child or incapable adult, the person making the application on their behalf) of the acceptance.

Temporary residents
     16.  - (1) The contractor may, if his list of patients is open, accept a person as a temporary resident provided he is satisfied that the person is -

(a) temporarily resident away from his normal place of residence and is not being provided with essential services (or their equivalent) under any other arrangement in the place where he is temporarily residing; or

(b) moving from place to place and not for the time being resident in any place.

    (2) For the purposes of sub-paragraph (1), a person shall be regarded as temporarily resident in a place if, when he arrives in that place, he intends to stay there for more than 24 hours but not more than three months.

    (3) A contractor which wishes to terminate his responsibility for a person accepted as a temporary resident before the end of -

(a) three months; or

(b) such shorter period for which he agreed to accept him as a patient,

shall notify him either orally or in writing and his responsibility for that patient shall cease 7 days after the date on which the notification was given.

    (4) At the end of three months, or on such earlier date as his responsibility for the temporary resident has come to an end, the contractor shall notify the Board in writing of any person whom he accepted as a temporary resident.

Refusal of applications for inclusion in the list of patients or for acceptance as a temporary resident
     17.  - (1) The contractor shall only refuse an application made under paragraph 15 or 16 if he has reasonable grounds for doing so which do not relate to the applicant's race, gender, social class, marital status, age, religion, political opinion, sexual orientation, appearance, disability, medical condition or whether or not the applicant has dependants.

    (2) The reasonable grounds referred to in paragraph (1) shall, in the case of applications made under paragraph 15, include the ground that the applicant does not live in the contractor's practice area.

    (3) A contractor which refuses an application made under paragraph 15 or 16 shall, within 14 days of his decision, notify the applicant (or, in the case of a child or incapable adult, the person making the application on their behalf) in writing of the refusal and the reason for it.

    (4) The contractor shall keep a written record of refusals of applications made under paragraph 15 and of the reasons for them and shall make this record available to the Board on request.

Patient preference of practitioner
     18.  - (1) Where the contractor has accepted an application for inclusion in his list of patients, he shall -

(a) notify the patient (or, in the case of a child or incapable adult, the person who made the application on their behalf) of the patient's right to express a preference to receive services from a particular performer or class of performer either generally or in relation to any particular condition; and

(b) record in writing any such preference expressed by or on behalf of the patient.

    (2) The contractor shall endeavour to comply with any reasonable preference expressed under sub-paragraph (1) but need not do so if the preferred performer -

(a) has reasonable grounds for refusing to provide services to the patient; or

(b) does not routinely perform the service in question within the practice.

Removal from the list at the request of the patient
     19.  - (1) The contractor shall notify the Board in writing of any request for removal from his list of patients received from a registered patient.

    (2) Where the Board -

(a) receives notification from the contractor under sub-paragraph (1); or

(b) receives a request from the patient to be removed from the contractor's list of patients,

it shall remove that person from the contractor's list of patients.

    (3) A removal in accordance with sub-paragraph (2) shall take effect -

(a) on the date on which the Board receives notification of the registration of the person with another provider of essential services (or their equivalent); or

(b) 14 days after the date on which the notification or request made under sub-paragraph (1) or (2) respectively is received by the Board,

whichever is the sooner.

    (4) The Board shall, as soon as practicable, notify in writing -

(a) the patient; and

(b) the contractor,

that the patient's name will be or has been removed from the contractor's list of patients on the date referred to in sub-paragraph (3).

    (5) In this paragraph and in paragraphs 20(1)(b) and (10), 21(6) and (7), 23 and 26, a reference to a request received from or advice, information or notification required to be given to a patient shall include a request received from or advice, information or notification required to be given to -

(a) in the case of a patient who is a child, a parent or other person referred to in paragraph 15(4)(a); or

(b) in the case of an adult patient who is incapable of making the relevant request or receiving the relevant advice, information or notification, a relative or the primary carer of the patient.

Removal from the list at the request of the contractor
     20.  - (1) Subject to paragraph 21, a contractor which has reasonable grounds for wishing a patient to be removed from his list of patients which do not relate to the applicant's race, gender, social class, marital status, age, religion, political opinion, sexual orientation, appearance, disability, medical condition, or whether or not the applicant has dependants shall -

(a) notify the Board in writing that he wishes to have the patient removed; and

(b) subject to sub-paragraph (2), notify the patient of his specific reasons for requesting removal.

    (2) Where in the reasonable opinion of the contractor -

(a) the circumstances of the removal are such that it is not appropriate for a more specific reason to be given; and

(b) there has been an irrevocable breakdown in the relationship between the patient and the contractor,

the reason given under sub-paragraph (1) may consist of a statement that there has been such a breakdown.

    (3) Except in the circumstances specified in sub-paragraph (4), a contractor may only request a removal under sub-paragraph (1), if, within the period of 12 months prior to the date of his request to the Board, he has warned the patient that he is at risk of removal and explained to him the reasons for this.

    (4) The circumstances referred to in sub-paragraph (3) are that -

(a) the reason for removal relates to a change of address;

(b) the contractor has reasonable grounds for believing that the issue of such a warning would -


(i) be harmful to the physical or mental health of the patient, or

(ii) put at risk the safety of one or more of the persons specified in sub-paragraph (5); or



(c) it is, in the opinion of the contractor, not otherwise reasonable or practical for a warning to be given.

    (5) The persons referred to in sub-paragraph (4) are -

(a) the contractor, where he is an individual medical practitioner;

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

(c) in the case of a contract with a company, a legal and beneficial owner of shares in that company;

(d) a member of the contractor's staff;

(e) a person engaged by the contractor to perform or assist in the performance of services under the contract; or

(f) any other person present -


(i) on the practice premises, or

(ii) in the place where services are being provided to the patient under the contract.

    (6) The contractor shall record in writing -

(a) the date of any warning given in accordance with sub-paragraph (3) and the reasons for giving such a warning as explained to the patient; or

(b) the reason why no such warning was given.

    (7) The contractor shall keep a written record of removals under this paragraph which shall include -

(a) the reason for removal given to the patient;

(b) the circumstances of the removal; and

(c) in cases where sub-paragraph (2) applies, the grounds for a more specific reason not being appropriate,

and shall make this record available to the Board on request.

    (8) A removal requested in accordance with sub-paragraph (1) shall, subject to sub-paragraph (9), take effect from -

(a) the date on which the Board receives notification of the registration of the person with another provider of essential services (or their equivalent); or

(b) the eighth day after the Board receives the notice referred to in sub-paragraph (1)(a),

whichever is the sooner.

    (9) Where, on the date on which the removal would take effect under sub-paragraph (8), the contractor is treating the patient at intervals of less than seven days, the contractor shall notify the Board in writing of the fact and the removal shall take effect -

(a) on the eighth day after the Board receives notification from the contractor that the person no longer needs such treatment; or

(b) on the date on which the Board receives notification of the registration of the person with another provider of essential services (or their equivalent),

whichever is the sooner.

    (10) The Board shall notify in writing -

(a) the patient; and

(b) the contractor,

that the patient's name has been or will be removed from the contractor's list of patients on the date referred to in sub-paragraph (8) or (9).

Removals from the list of patients who are violent
     21.  - (1) A contractor which wishes a patient to be removed from his list of patients with immediate effect on the grounds that -

(a) the patient has committed an act of violence against any of the persons specified in sub-paragraph (2) or behaved in such a way that any such person has feared for his safety; and

(b) he has reported the incident to the police,

shall notify the Board in accordance with sub-paragraph (3).

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

(a) the contractor where he is a medical practitioner;

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

(c) in the case of a contract with a company, a legal and beneficial owner of shares in that company;

(d) a member of the contractor's staff;

(e) a person engaged by the contractor to perform or assist in the performance of services under the contract; or

(f) any other person present -


(i) on the practice premises, or

(ii) in the place where services were provided to the patient under contract.

    (3) Notification under sub-paragraph (1) may be given by any means including telephone or fax but if not given in writing shall subsequently be confirmed in writing within seven days (and for this purpose a faxed notification is not a written one).

    (4) The Board shall acknowledge in writing receipt of a request from the contractor under sub-paragraph (1).

    (5) A removal requested in accordance with sub-paragraph (1) shall take effect at the time that the contractor -

(a) makes the telephone call to the Board; or

(b) sends or delivers the notification to the Board.

    (6) Where, pursuant to this paragraph, the contractor has notified the Board that he wishes to have a patient removed from his list of patients, it shall inform the patient concerned unless -

(a) it is not reasonably practicable for it to do so; or

(b) it has reasonable grounds for believing that to do so would -


(i) be harmful to the physical or mental health of the patient; or

(ii) put at risk the safety of one or more of the persons specified in sub-paragraph (2).

    (7) Where the Board has removed a patient from the contractor's list of patients in accordance with sub-paragraph (5), it shall give written notice of the removal to that patient.

    (8) Where a patient is removed from the contractor's list of patients in accordance with this paragraph, the contractor shall record in the patient's medical records that the patient has been removed under this paragraph and the circumstances leading to his removal.

Removals from the list of patients registered elsewhere
     22.  - (1) The Board shall remove a patient from the contractor's list of patients if -

(a) the patient has subsequently been registered with another provider of essential services (or their equivalent) in the area of the Board; or

(b) it has received notice from another Board, a Primary Care Trust, a Local Health Board or a Health Board that the patient has subsequently been registered with a provider of essential services (or their equivalent) outside the area of the Board.

    (2) A removal in accordance with sub-paragraph (1) shall take effect -

(a) on the date on which the Board receives notification of the registration of the person with the new provider; or

(b) with the consent of the Board, on such other date as has been agreed between the contractor and the new provider.

    (3) The Board shall notify the contractor in writing of persons removed from his list of patients under sub-paragraph (1).

Removals from the list of patients who have moved
     23.  - (1) Subject to sub-paragraph (2), where the Board is satisfied that a person on the contractor's list of patients has moved and no longer resides in that contractor's practice area, the Board shall -

(a) inform that patient and the contractor that the contractor is no longer obliged to visit and treat the person;

(b) advise the patient in writing either to obtain the contractor's agreement to the continued inclusion of the person on his list of patients or to apply for registration with another provider of essential services (or their equivalent); and

(c) inform the patient that if, after the expiration of 30 days from and including the date of the advice mentioned in paragraph (b), he has not acted in accordance with the advice and informed it accordingly, the Board will remove him from the contractor's list of patients.

    (2) If, at the expiration of the period of 30 days referred to in sub-paragraph (1)(c), the Board has not been notified of the action taken, it shall remove the patient from the contractor's list of patients and inform him and the contractor accordingly.

     24. Where the address of a patient who is on the contractor's list of patients is no longer known to the Board, the Board shall -

(a) give to the contractor notice in writing that it intends, at the end of the period of six months commencing with the date of the notice, to remove the patient from the contractor's list of patients; and

(b) at the end of that period, remove the patient from the contractor's list of patients unless, within that period, the contractor satisfies the Board that he is still responsible for providing essential services to that patient.

Removals from the list of patients absent from the United Kingdom etc.
     25.  - (1) The Board shall remove a patient from the contractor's list of patients where it receives notification that that patient -

(a) intends to be away from the United Kingdom for a period of at least three months;

(b) is in Her Majesty's Forces;

(c) is serving a prison sentence of more than two years or sentences totalling in the aggregate more than that period;

(d) has been absent from the United Kingdom for a period of more than three months; or

(e) has died.

    (2) A removal in accordance with sub-paragraph (1) shall take effect -

(a) in the cases referred to in sub-paragraph (1)(a) to (c) from the date of the departure, enlistment or imprisonment or the date on which the Board first receives notification of the departure, enlistment or imprisonment whichever is the later; or

(b) in the cases referred to in sub-paragraph (1)(d) and (e) from the date on which the Board first receives notification of the absence or death.

    (3) The Board shall notify the contractor in writing of patients removed from his list of patients under sub-paragraph (1).

Removals from the list of patients accepted elsewhere as temporary residents
     26.  - (1) The Board shall remove from the contractor's list of patients a patient who has been accepted as a temporary resident by another contractor or other provider of essential services (or their equivalent) where it is satisfied, after due inquiry -

(a) that the patient's stay in the place of temporary residence has exceeded three months; and

(b) that he has not returned to his normal place of residence or any other place within the contractor's practice area.

    (2) The Board shall notify in writing of a removal under sub-paragraph (1) -

(a) the contractor; and

(b) where practicable, the patient.

    (3) A notification to the patient under sub-paragraph (2)(b) shall inform him of -

(a) his entitlement to make arrangements for the provision to him of essential services (or their equivalent), including by the contractor by which he has been treated as a temporary resident; and

(b) the name and address of the Board in whose area he is resident.

Removals from the list of pupils etc. of a school
     27.  - (1) Where the contractor provides essential services under the contract to persons on the grounds that they are pupils at or staff or residents of a school, the Board shall remove from the contractor's list of patients any such persons who do not appear on particulars of persons who are pupils at or staff or residents of that school provided by that school.

    (2) Where the Board has made a request to a school to provide the particulars mentioned in sub-paragraph (1) and has not received them, it shall consult the contractor as to whether it should remove from his list of patients any persons appearing on that list as pupils at, or staff or residents of, that school.

    (3) The Board shall notify the contractor in writing of patients removed from his list of patients under sub-paragraph (1).

Termination of responsibility for patients not registered with the contractor
     28.  - (1) Where a contractor -

(a) has received an application for the provision of medical services other than essential services -


(i) from a person who is not included in his list of patients,

(ii) from a person whom he has not accepted as a temporary resident, or

(iii) on behalf of a person mentioned in head (a)(i) or (ii), from one of the persons specified in paragraph 15(4); and



(b) has accepted that person as a patient for the provision of the service in question,

his responsibility for that patient shall be terminated in the circumstances referred to in sub-paragraph (2).

    (2) The circumstances referred to in sub-paragraph (1) are -

(a) the patient informs the contractor that he no longer wishes him to be responsible for provision of the service in question;

(b) in cases where the contractor has reasonable grounds for terminating his responsibility which do not relate to the person's race, gender, social class, marital status, age, religion, political opinion, sexual orientation, appearance, disability, medical condition or whether or not the patient has dependants, the contractor informs the patient that he no longer wishes to be responsible for providing him with the service in question; or

(c) it comes to the notice of the contractor that the patient -


(i) no longer resides in the area for which the contractor has agreed to provide the service in question; or

(ii) is no longer included in the list of patients of an other contractor to whose registered patients the contractor has agreed to provide that service.

    (3) A contractor which wishes to terminate his responsibility for a patient under sub-paragraph (2)(b) shall notify the patient of the termination and the reason for it.

    (4) The contractor shall keep a written record of terminations under this paragraph and of the reasons for them and shall make this record available to the Board on request.

    (5) A termination under sub-paragraph (2)(b) shall take effect -

(a) from the date on which the notice is given where the grounds for termination are those specified in paragraph 21(1); or

(b) in all other cases, 14 days from the date on which the notice is given.

Closure of lists of patients
     29.  - (1) A contractor which wishes to close his list of patients shall notify the Board in writing to that effect.

    (2) Within a period of 7 days beginning with and including the date of receipt of the notification referred to in sub-paragraph (1), or, if that is not reasonably practicable as soon as is practicable thereafter, the Board shall enter into discussions with the contractor concerning the support which the Board may give the contractor, or other changes which the Board or the contractor may make, which would enable the contractor to keep his list of patients open.

    (3) In the discussions referred to in sub-paragraph (2), both parties shall use reasonable endeavours to achieve the aim of keeping the contractor's list of patients open.

    (4) The discussions mentioned in sub-paragraph (2) shall be completed within a period of 28 days beginning with and including the date of the Board's receipt of the notification referred to in sub-paragraph (1), or within such longer period as the parties may agree.

    (5) If, following the discussions mentioned in sub-paragraph (2), the Board and the contractor reach agreement that the contractor's list of patients should remain open, the Board shall send full details of the agreement in writing to the contractor.

    (6) The Board and the contractor shall comply with the terms of an agreement reached as mentioned in sub-paragraph (5).

    (7) If, following the discussions mentioned in sub-paragraph (2) -

(a) the Board and the contractor reach agreement that the contractor's list of patients should close; or

(b) the Board and the contractor fail to reach agreement and the contractor still wishes to close his list of patients,

the contractor shall send a closure notice to the Board.

    (8) A closure notice shall be submitted in the form specified in Schedule 6, and shall include the following details which (in a case falling within sub-paragraph (7)(a)) have been agreed between the parties or (in a case falling within sub-paragraph (7)(b)) are proposed by the contractor -

(a) the period of time (which may not exceed 12 months) for which the contractor's list of patients will be closed;

(b) the current number of the contractor's registered patients;

(c) the number of registered patients (lower than the current number of such patients, and expressed either in absolute terms or as a percentage of the number of such patients specified pursuant to head (b)) which, if that number were reached, would trigger the re-opening of the contractor's list of patients;

(d) the number of registered patients (expressed either in absolute terms or as a percentage of the number of such patients specified pursuant to head (b)) which, if that number were reached, would trigger the re-closure of the contractor's list of patients; and

(e) any withdrawal from or reduction in provision of any additional or enhanced services which had previously been provided under the contract.

    (9) The Board shall forthwith acknowledge receipt of the closure notice in writing to the contractor.

    (10) Before the Board reaches a decision as to whether to approve or reject the closure notice under sub-paragraph (12), the Board and the contractor may enter into further discussions concerning the details of the closure notice as referred to in sub-paragraph (8), with a view to reaching agreement; and, in particular, if the parties are unable to reach agreement regarding the period of time for which the contractor's list of patients will be closed, that period shall be 12 months.

    (11) A contractor may not withdraw a closure notice for a period of three months beginning with and including the date on which the Board has received the notice, unless the Board has agreed otherwise in writing.

    (12) Within a period of 14 days beginning with and including the date of receipt of the closure notice, the Board shall -

(a) approve the closure notice; or

(b) reject the closure notice,

and shall notify the contractor of its decision in writing as soon as possible.

    (13) Approval of the closure notice under sub-paragraph (12)(a) includes approval of the details specified in accordance with sub-paragraph (8) or, where those details are revised following discussions under sub-paragraph (10), approval of those details as so revised.

Approval of closure notice by the Board
     30.  - (1) If the Board approves the closure notice in accordance with paragraph 29(12)(a), the contractor shall close his list of patients -

(a) with effect from a date agreed between the Board and the contractor; or

(b) if no such agreement has been reached, with effect from the date on which the contractor receives notification of the Board's decision to approve the closure notice.

    (2) Subject to sub-paragraph (3), the contractor's list of patients shall remain closed for the period specified in the closure notice in accordance with paragraph 29(8)(a) (or, where the period of 12 months specified in paragraph 29(10) applies, for that period).

    (3) The contractor's list of patients shall re-open before the expiry of the period mentioned in sub-paragraph (2) if -

(a) the number of the contractor's registered patients falls to the number specified in the closure notice in accordance with paragraph 29(8)(c); or

(b) the Board and the contractor agree that the list of patients should re-open.

    (4) If the contractor's list of patients has re-opened pursuant to sub-paragraph (3)(a), it shall nevertheless close again if, during the period specified in the closure notice in accordance with paragraph 29(8)(a) (or, where the period of 12 months specified in paragraph 29(10) applies, during that period) the number of the contractor's registered patients rises to the number specified in the closure notice in accordance with paragraph 29(8)(d).

    (5) Except in cases where the contractor's list of patients is already open pursuant to sub-paragraph (3), the Board shall notify the contractor in writing between 7 and 14 days before the expiry of the period of closure specified in sub-paragraph (2), confirming the date on which the contractor's list of patients will re-open.

    (6) Where the details specified in the closure notice in accordance with paragraph 29(8) have been revised following discussions under paragraph 29(10), references in this paragraph to details specified in the closure notice are references to those details as so revised.

Rejection of closure notice by the Board
     31.  - (1) This regulation applies where the Board rejects the closure notice in accordance with paragraph 29(12)(b).

    (2) The contractor and the Board may not refer the matter for determination in accordance with the dispute resolution procedure (or, where applicable, commence court proceedings) until the assessment panel has given its determination in accordance with the following sub-paragraphs.

    (3) The Board must ensure that the assessment panel is appointed as soon as is practicable to consider and determine whether the contractor should be permitted to close his list of patients, and if so, the terms on which he should be permitted to do so.

    (4) The Board shall provide the assessment panel with such information as the assessment panel may reasonably require to enable it to reach a determination and shall include in such information any written observations received from the contractor.

    (5) The members of the assessment panel shall be -

(a) the Chief Executive of the Board of which the assessment panel is a committee or sub-committee;

(b) a person representative of the patients in an area other than that of the Board which is a party to the contract; and

(c) a person representative of a Local Medical Committee which does not represent practitioners in the area of the Board which is a party to the contract.

    (6) At least one member of the assessment panel shall visit the contractor before reaching a determination under sub-paragraph (7).

    (7) Within the period of 28 days beginning with and including the date on which the Board rejected the closure notice, the assessment panel shall -

(a) approve the list closure; or

(b) reject the list closure,

and shall notify the Board and the contractor of its determination in writing as soon as possible.

    (8) Where the assessment panel determines in accordance with sub-paragraph (7)(a) that the contractor's list of patients should close, it shall specify -

(a) a date from which the closure shall take effect, which must be within a period of 7 days beginning with and including the date of the assessment panel's determination; and

(b) those details specified in paragraph 29(8).

    (9) Where the assessment panel determines in accordance with sub-paragraph (7)(b) that the contractor's list of patients may not close, that list shall remain open, and the Board and the contractor shall enter into discussions with a view to ensuring that the contractor receives support from the Board which will enable him to continue to provide services safely and effectively.

    (10) Where the assessment panel determines in accordance with sub-paragraph (7)(b) that the contractor's list of patients may not close, the contractor may not submit a further closure notice as described in paragraph 29 until -

(a) the expiry of a period of three months beginning with and including the date of the assessment panel's determination; or

(b) (if applicable) the final determination of the dispute resolution procedure (or any court proceedings),

whichever is the later, unless there has been a change in the circumstances of the contractor which affects his ability to deliver services under the contract.

Assignment of patients to lists: open lists
     32.  - (1) A Board may, subject to paragraph 34, assign a new patient to a contractor whose list of patients is open.

    (2) In this paragraph and in paragraphs 33 and 35 to 37, a "new" patient means a person who -

(a) is resident (whether or not temporarily) within the area of the Board;

(b) has been refused inclusion in a list of patients of, or has not been accepted as a temporary resident by, a contractor whose premises are within such an area; and

(c) wishes to be included in the list of patients of a contractor whose practice premises are within that area.

Assignment of patients to lists: closed lists
     33.  - (1) A Board may not assign a new patient to a contractor which has closed his list of patients except in the circumstances specified in sub-paragraph (2).

    (2) A Board may, subject to paragraph 34, assign a new patient to a contractor whose practice premises are within the Board's area and which has closed his list of patients, if -

(a) most or all of the providers of essential services (or their equivalent) whose practice premises are within the Board's area have closed their lists of patients;

(b) the assessment panel has determined under paragraph 35(7) that patients may be assigned to the contractor in question, and that determination has not been overturned either by a determination of the Department under paragraph 36(13) or (where applicable) by a court; and

(c) the Board has entered into discussions with the contractor in question regarding the assignment of a patient if such discussions are required under paragraph 37.

Factors relevant to assignments
     34. In making an assignment to a contractor under paragraph 32 or 33, the Board shall have regard to -

(a) the wishes and circumstances of the patient to be assigned;

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

(c) whether, during the six months ending on the date on which the application for assignment is received by the Board, the patient's name has been removed from the list of patients of any contractor in the area of the Board under paragraph 20 or its equivalent provision in relation to an Article 15B provider in the area of the Board;

(d) whether the patient's name has been removed from the list of patients of any contractor in the area of the Board under paragraph 21 or its equivalent provision in relation to an Article 15B provider in the area of the Board and, if so, whether the contractor has appropriate facilities to deal with such a patient;

(e) such other matters as the Board considers to be relevant.

Assignments to closed lists: determinations of the assessment panel
     35.  - (1) This paragraph applies where most or all of the providers of essential services (or their equivalent) whose practice premises are within the area of a Board have closed their lists of patients.

    (2) If the Board wishes to assign new patients to contractors which have closed their lists of patients, it must prepare a proposal to be considered by the assessment panel which must include details of those contractors to which the Board wishes to assign patients.

    (3) The Board must ensure that the assessment panel is appointed to consider and determine its proposal made under sub-paragraph (2), and the composition of the assessment panel shall be as described in paragraph 31(5).

    (4) The Board shall notify in writing -

(a) contractors or Article 15B providers whose practice premises are within the Board's area which -


(i) have closed their list of patients, and

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



(b) the Local Medical Committee for the area of the Board,

that it has referred the matter to the assessment panel.

    (5) In reaching its determination, the assessment panel shall have regard to relevant factors including -

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

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

    (6) The assessment panel shall reach a determination within the period of 28 days beginning with and including the date on which the panel was appointed.

    (7) The assessment panel shall determine whether the Board may assign patients to contractors which have closed their lists of patients; and if it determines that the Board may make such assignments, it shall also determine those contractors to which patients may be assigned.

    (8) The assessment panel may determine that the Board may assign patients to contractors other than those contractors specified by the Board in its proposal under sub-paragraph (2), as long as the contractors were notified under sub-paragraph (4)(a).

    (9) The assessment panel's determination shall include its comments on the matters specified in sub-paragraph (5), and shall be notified in writing to those contractors which were notified under sub-paragraph (4)(a).

Assignments to closed lists: dispute resolution procedure relating to determinations of the assessment panel
     36.  - (1) Where an assessment panel makes a determination under paragraph 35(7) that the Board may assign new patients to contractors which have closed their lists of patients, any contractor specified in that determination may refer the matter to the Department to review the determination of the assessment panel.

    (2) Where a matter is referred to the Department in accordance with sub-paragraph (1), it shall be reviewed in accordance with the procedure specified in the following sub-paragraphs.

    (3) Where more than one contractor specified in the determination in accordance with paragraph 35(7) wishes to refer the matter for dispute resolution, those contractors may, if they all agree, refer the matter jointly, and in that case the Department shall review the matter in relation to those contractors together.

    (4) Within the period of 7 days beginning with and including the date of the determination by the assessment panel in accordance with paragraph 35(7), the contractor shall send to the Department a written request for dispute resolution which shall include or be accompanied by -

(a) the names and addresses of the parties to the dispute;

(b) a copy of the contract (or contracts); and

(c) a brief statement describing the nature and circumstances of the dispute.

    (5) Within the period of 7 days beginning with and including the date on which the matter was referred to it, the Department shall -

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

(b) include with the notice a written request to the parties to make in writing within a specified period any representations which they may wish to make about the dispute.

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

    (7) The Department shall, upon receiving any representations from a party, give a copy of them to the other party, and shall in each case request (in writing) a party to which a copy of the representations is given to make within a specified period any written observations which it wishes to make on those representations.

    (8) For the purpose of assisting it in its consideration of the matter, the Department may -

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

(b) consult other persons whose expertise it considers will assist it in its consideration of the dispute.

    (9) Where the Department consults another person under sub-paragraph (8)(b), it shall notify the parties accordingly in writing and, where it considers that the interests of any party might be substantially affected by the result of the consultation, it shall give to the parties such opportunity as it considers reasonable in the circumstances to make observations on those results.

    (10) In considering the dispute, the Department shall consider -

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

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

(c) any oral representations made in response to an invitation under sub-paragraph (8)(a);

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

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

    (11) Subject to the other provisions of this paragraph and to any agreement by the parties, the Department shall have wide discretion in determining the procedure of the dispute resolution to ensure the just, expeditious, economical and final determination of the dispute.

    (12) In this paragraph, "specified period" means such period as the Department shall specify in the request, being not less than one, nor more than two, weeks beginning with and including the date on which the notice referred to is given, but the Department may, if the period for determination of the dispute has been extended in accordance with sub-paragraph (16), extend any such period (even after it has expired) and, where it does so, a reference in this paragraph to the specified period is to the period as so extended.

    (13) Subject to sub-paragraph (16), within the period of 21 days beginning with and including the date on which the matter was referred to it, the Department shall determine whether the Board may assign patients to contractors which have closed their lists of patients; and if it determines that the Board may make such assignments, it shall also determine those contractors to which patients may be assigned.

    (14) The Department may not determine that patients may be assigned to a contractor which was not specified in the determination of the assessment panel under paragraph 35(7).

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

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

(a) the Department;

(b) the Board; and

(c) the contractor which referred the matter to dispute resolution.

    (17) The Department shall record its determination, and the reasons for it, in writing and shall give notice of the determination (including the record of the reasons) to the parties.

Assignments to closed lists: assignments of patients by a Board
     37.  - (1) Before the Board may assign a new patient to a contractor, it shall, subject to sub-paragraph (3), enter into discussions with that contractor regarding additional support that the Board can offer the contractor, and the Board shall use its best endeavours to provide appropriate support.

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

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

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

(b) to any subsequent assignment to that contractor to the extent that it is reasonable and appropriate having regard to the numbers of patients who have been or may be assigned to him and the period of time since the last discussions under sub-paragraph (1) took place.

    (3) Where a prescriber orders the drug buprenorphine or a drug specified in Schedule 2 to the Misuse of Drugs Regulations (Northern Ireland) 2002 (controlled drugs to which regulations 14, 15, 16, 18, 19, 20, 21, 23, 26 and 27 of those Regulations apply)[69] for supply by instalments for treating addiction to any drug specified in that Schedule, he shall -

(a) specify the number of instalments to be dispensed and the interval between each instalment; and

(b) order only such quantity of the drug as will provide treatment for a period not exceeding 14 days.

    (4) In a case of urgency a prescriber may request a chemist to dispense a drug or medicine before a prescription form is issued, only if -

(a) that drug or medicine is not a Scheduled drug;

(b) that drug is not a controlled drug within the meaning of the Misuse of Drugs Act 1971[70], other than a drug which is for the time being specified in Schedules 4 or 5 to the Misuse of Drugs Regulations (Northern Ireland) 2002[71]; and

(c) he undertakes to furnish the chemist, within 72 hours, with a prescription form completed in accordance with sub-paragraph (3).

    (5) In a case of urgency a prescriber may request a chemist to dispense an appliance before a prescription form is issued only if -

(a) that appliance does not contain a Scheduled drug or a controlled drug within the meaning of the Misuse of Drugs Act 1971, other than a drug which is for the time being specified in Schedule 5 to the Misuse of Drugs Regulations (Northern Ireland) 2002;

(b) in the case of a restricted availability appliance, the patient is a person, or it is for a purpose, specified in the Drug Tariff; and

(c) he undertakes to furnish the chemist, within 72 hours, with a prescription form completed in accordance with sub-paragraph (3).

Restrictions on prescribing by medical practitioners
     40.  - (1) In the course of treating a patient to whom he is providing treatment under the contract, a medical practitioner shall not order on a prescription form a drug, medicine or other substance specified in any directions given by the Department under Article 57D of the Order[72] as being drugs, medicines or other substances which may not be ordered for patients in the provision of medical services under the contract but may, subject to regulation 24(2)(b), prescribe such a drug, medicine or other substance for that patient in the course of that treatment under a private arrangement.

    (2) In the course of treating a patient to whom he is providing treatment under the contract, a medical practitioner shall not order on a prescription form a drug, medicine or other substance specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which can only be ordered for specified patients and specified purposes unless -

(a) that patient is a person of the specified description;

(b) that drug, medicine or other substance is prescribed for that patient only for the specified purpose; and

(c) the practitioner endorses the form with the reference "SL2",

but may, subject to regulation 24(2)(b), prescribe such a drug, medicine or other substance for that patient in the course of that treatment under a private arrangement.

    (3) In the course of treating a patient to whom he is providing treatment under the contract, a medical practitioner shall not order on a prescription form a restricted availability appliance unless -

(a) the patient is a person, or it is for a purpose, specified in the Drug Tariff; and

(b) the practitioner endorses the face of the form with the reference "SL2",

but may, subject to regulation 24(2)(b), prescribe such an appliance for that patient in the course of that treatment under a private arrangement.

Restrictions on prescribing by supplementary prescribers
     41.  - (1) The contractor shall have arrangements in place to secure that a supplementary prescriber will -

(a) give a prescription for a prescription only medicine;

(b) administer a prescription only medicine for parenteral administration; or

(c) give directions for the administration of a prescription only medicine for parenteral administration,

as a supplementary prescriber only under the conditions set out in sub-paragraph (2).

    (2) The conditions referred to in sub-paragraph (1) are that -

(a) the person satisfies the applicable conditions set out in Article 3B(3) of the POM Order (prescribing and administration by supplementary prescribers)[73], unless those conditions do not apply by virtue of any of the exemptions set out in the subsequent provisions of that Order;

(b) the medicine is not a controlled drug within the meaning of the Misuse of Drugs Act 1971;

(c) the drug, medicine or other substance is not specified in any directions given by the Department under Article 57D of the Order[74] as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract;

(d) the drug, medicine or other substance is not specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which can only be ordered for specified patients and specified purposes unless -


(i) the patient is a person of the specified description,

(ii) the medicine is prescribed for that patient only for the specified purposes, and

(iii) if a supplementary prescriber is giving a prescription, he endorses the face of the form with the reference "SL2".

    (3) Where the functions of a supplementary prescriber include prescribing, the contractor shall have arrangements in place to secure that that person will only give a prescription for -

(a) an appliance; or

(b) a medicine which is not a prescription only medicine,

as a supplementary prescriber under the conditions set out in sub-paragraph (4).

    (4) The conditions referred to in sub-paragraph (3) are that -

(a) the supplementary prescriber acts in accordance with a clinical management plan which is in effect at the time he acts and which contains the following particulars -


(i) the name of the patient to whom the plan relates,

(ii) the illness or conditions which may be treated by the supplementary prescriber,

(iii) the date on which the plan is to take effect, and when it is to be reviewed by the medical practitioner or dentist who is a party to the plan,

(iv) reference to the class or description of medicines or types of appliances which may be prescribed or administered under the plan,

(v) any restrictions or limitations as to the strength or dose of any medicine which may be prescribed or administered under the plan, and any period of administration or use of any medicine or appliance which may be prescribed or administered under the plan,

(vi) relevant warnings about known sensitivities of the patient to, or known difficulties of the patient with, particular medicines or appliances,

(vii) the arrangements for notification of -


(aa) suspected or known adverse reactions to any medicine which may be prescribed or administered under the plan, and suspected or known adverse reactions to any other medicine taken at the same time as any medicine prescribed or administered under the plan,

(bb) incidents occurring with the appliance which might lead, might have led or has led to the death or serious deterioration of state of health of the patient, and



(viii) the circumstances in which the supplementary prescriber should refer to, or seek the advice of, the medical practitioner or dentist who is a party to the plan;



(b) he has access to the health records of the patient to whom the plan relates which are used by any medical practitioner or dentist who is a party to the plan;

(c) if it is a prescription for a medicine, the medicine is not a controlled drug within the meaning of the Misuse of Drugs Act 1971;

(d) if it is a prescription for a drug, medicine or other substance, that drug, medicine or other substance is not specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract;

(e) if it is a prescription for a drug, medicine or other substance, that drug, medicine or other substance is not specified in any directions given by the Department under Article 57D of the Order as being a drug, medicine or other substance which can only be ordered for specified patients and specified purposes unless -



(i) the patient is a person of the specified description,

(ii) the medicine is prescribed for that patient only for the specified purposes, and

(iii) when giving the prescription, he endorses the face of the form with the reference "SL2";



(f) if it is a prescription for a medicine -



(i) the medicine is the subject of a product licence, a marketing authorisation or a homeopathic certificate of registration granted by the licensing authority or the European Commission, or

(ii) subject to sub-paragraph (6), the use of the medicine is for the purposes of a clinical trial, and


(aa) that trial is subject of a clinical trial certificate issued in accordance with the Medicines Act 1968[75], or

(bb) a clinical trial certificate is not needed in respect of that trial by virtue of any exemption conferred by or under that Act;



(g) if it is a prescription for an appliance, the appliance is listed in Part IX of the Drug Tariff; and

(h) if it is a prescription for a restricted availability appliance -



(i) the patient is a person of a description mentioned in the entry in Part IX of the Drug Tariff in respect of that appliance,

(ii) the appliance is prescribed only for the purposes specified in respect of that person in that entry, and

(iii) when giving the prescription, he endorses the face of the form with the reference "SL2".

    (5) In sub-paragraph (4)(a), "clinical management plan" means a written plan (which may be amended from time to time) relating to the treatment of an individual patient agreed by -

(a) the patient to whom the plan relates;

(b) the medical practitioner or dentist who is a party to the plan; and

(c) any supplementary prescriber who is to prescribe, give directions for administration or administer under the plan.

    (6) In relation to any time from the coming into operation of any regulations made by the Secretary of State under section 2(2) of the European Communities Act 1972 (general implementation of treaties)[76], to implement Directive 2001/83/EC on the Community code relating to medicinal products for human use[77], sub-paragraph (f)(ii) shall be read as if it referred to a clinical trial which has been authorised, or is treated as having been authorised by licensing authority for the purposes of those Regulations.

Interpretation of paragraphs 38, 39, 40 and 41
     42. For the purposes of paragraphs 38, 39, 40 and 41 in their application to a contractor whose contract includes the provision of contraceptive services, drugs includes contraceptive substances and appliances includes contraceptive appliances.

Excessive prescribing
     43.  - (1) The contractor shall not prescribe drugs, medicines or appliances whose cost or quantity, in relation to any patient, is, by reason of the character of the drug, medicine or appliance in question in excess of that which was reasonably necessary for the proper treatment of that patient.

    (2) In considering whether a contractor has breached his obligations under sub-paragraph (1), the Board shall seek the views of the Local Medical Committee (if any) for its area.

Provision of dispensing services
     44.  - (1) Without prejudice to any separate right a medical practitioner may have under regulation 12 of the Pharmaceutical Regulations (arrangements for provision of pharmaceutical services by doctors)[78], a contractor may provide dispensing services to his registered patients under the contract only if he is required to do so by the Board in accordance with the following provisions of this paragraph.

    (2) A contractor may provide dispensing services to his registered patients only if he is required to do so by the Board in accordance with the following provisions of this paragraph.

    (3) Where the Board, is satisfied that a person, by reason of -

(a) distance;

(b) inadequacy of means of communication; or

(c) other exceptional circumstances,

will have serious difficulty in obtaining from a chemist any drugs, medicines or appliances, other than scheduled drugs, required for that person's treatment, the Board shall require the contractor with whom the person is a registered patient to supply such drugs, medicines and appliances to that person until further notice.

    (4) Notwithstanding anything contained in sub-paragraph (3) -

(a) a contractor shall not be required to undertake the supply of drugs, medicines and appliances under sub-paragraph (3) if the contractor satisfies the Board that the contractor does not normally provide dispensing services under the contract;

(b) a contractor shall be entitled to receive reasonable notice from the Board that the contractor is required to undertake the supply of drugs, medicines and appliances under sub-paragraph (2) or that such supply is to be discontinued.

    (5) A contractor which is required under this paragraph to provide dispensing services to some or all of his registered patients may provide any necessary dispensing services to a person whom that contractor has accepted as a temporary resident.

Terms relating to the provision of dispensing services
     45.  - (1) A contractor which has been required to secure the provision of dispensing services under paragraph 44 shall ensure that dispensing services are provided in accordance with the following sub-paragraphs.

    (2) Subject to sub-paragraphs (3) and (4), a contractor providing dispensing services shall -

(a) record an order for the provision of any drugs, medicines or appliances which are needed for the treatment of the patient on a prescription form completed in accordance with paragraph 39(3);

(b) provide those drugs, medicines or appliances in a suitable container;

(c) provide for the patient a drug or medicine specified in any directions given by the Department under Article 57D of the Order[79] as being a drug or medicine which can only be ordered for specified patients and specified purposes only if -


(i) that patient is a person of the specified description, and

(ii) the drug or medicine is supplied for that patient only for the specified purpose; and



(d) provide for the patient a restricted availability appliance only if the patient is a person, or it is for a purpose, specified in the Drug Tariff.

    (3) Sub-paragraph (2) does not apply to drugs, medicines or appliances ordered on a prescription form by an independent nurse prescriber.

    (4) Where a patient presents an order on a prescription form for drugs, medicines or appliances signed by an independent nurse prescriber, or an order for a restricted availability appliance signed by and endorsed on its face with the reference "SL2" by an independent nurse prescriber, to a contractor who may provide dispensing services, the contractor may provide to the patient such of the drugs, medicines or appliances so ordered as he supplies in the normal course of his practice.

    (5) Drugs, medicines or appliances provided under sub-paragraph (4) shall be provided in a suitable container.

    (6) A contractor providing dispensing services shall not provide for a patient a drug or medicine specified in any directions given by the Department under Article 57D of the Order as being drugs or medicines which may not be ordered for patients in the provision of medical services under the contract, except that, where it has ordered a drug or medicine which has an appropriate non-proprietary name either by the name or by its formula, it may provide a drug or medicine which has the same specification notwithstanding that it is a drug or medicine specified in such directions (but, in the case of a drug or medicine which combines more than one drug, only if the combination has an appropriate non-proprietary name).

    (7) Subject to sub-paragraph (9), nothing in this paragraph shall prevent a contractor providing a Scheduled drug or a restricted availability appliance in the course of treating a patient under a private arrangement.

    (8) A contractor providing dispensing services shall comply with paragraph 14A of Schedule 2 to the Pharmaceutical Regulations, as if modified as follows -

(a) for "paragraph 13(a)", substitute "sub-paragraph (3)(a)";

(b) for "paragraph 11A(2)", substitute "sub-paragraph (5)";

(c) for "a doctor who is required by the Board under regulation 12 to provide drugs and appliances to a patient", substitute "a contractor providing dispensing services to a patient"; and

(d) for "doctor", substitute "medical practitioner".

    (9) The provisions of regulation 24 (fees and charges) apply in respect of the provision of any drugs, medicines or appliances by a contractor providing dispensing services as they apply in respect of prescriptions for drugs, medicines or appliances.

    (10) A contractor who is entitled to provide dispensing services may, with the consent of the patient, order a drug, medicine or appliance for a patient on a prescription form, rather than providing it himself.

Dispensing contractor list
     46.  - (1) Where the contractor is required by the Board under paragraph 44 to provide dispensing services to his patients and is actually doing so, the Board shall include -

(a) the contractor's name; and

(b) the address of the practice premises from which he is required to dispense,

on a list of such contractors (to be called the dispensing contractors list) which it shall prepare, maintain and publish.

    (2) The Board shall remove the name of the contractor from the list referred to in sub-paragraph (1) where the contractor ceases to provide dispensing services to his patients.

Provision of drugs, medicines and appliances for immediate treatment or personal administration
     47.  - (1) Subject to sub-paragraph (2), a contractor -

(a) shall provide to a patient any drug, medicine or appliance, not being a Scheduled drug, where such provision is needed for the immediate treatment of that patient before a provision can otherwise be obtained; and

(b) may provide to a patient any drug, medicine or appliance, not being a Scheduled drug, which he personally administers or applies to that patient,

but shall, in either case, provide a restricted availability appliance only if it is for a person or a purpose specified in the Drug Tariff.

    (2) Nothing in sub-paragraph (1) authorises a person to supply any drug or medicine to a patient otherwise than in accordance with Part 3 of the Medicines Act 1968[80] or any regulations or orders made thereunder.

(a) included in the primary medical services performers list maintained by that Board;

(b) not suspended from that list or from the Medical Register; and

(c) not subject to interim suspension under section 41A of the Medical Act 1983[81].

    (2) Sub-paragraph (1)(a) shall not apply in the case of -

(a) a medical practitioner employed by a Heath and Social Services Trust, (in Scotland) a Health Board, an NHS Trust or an NHS foundation trust who is providing services other than primary medical services at the practice premises;

(b) a person who is provisionally registered under section 15, 15A or 21 of the Medical Act 1983[82] acting in the course of his employment in a resident medical capacity in an approved medical practice; or

(c) a GP Registrar during the first two months of his training period.

     49. No health care professional other than one to whom paragraph 48 applies shall perform clinical services under the contract unless he is appropriately registered with his relevant professional body and his registration is not currently suspended.

     50. Where the registration of a health care professional or, in the case of a medical practitioner, his inclusion in a primary medical services performers list is subject to conditions, the contractor shall ensure compliance with those conditions insofar as they are relevant to the contract.

     51. No health care professional shall perform any clinical services unless he has such clinical experience and training as are necessary to enable him properly to perform such services.

Conditions for employment and engagement
     52.  - (1) Subject to sub-paragraphs (2) and (3), a contractor shall not employ or engage a medical practitioner (other than one falling within paragraph 48(2)), unless -

(a) that practitioner has provided him with the name and address of the Board on whose primary medical services performers list he appears; and

(b) the contractor has checked that the practitioner meets the requirements in paragraph 48.

    (2) Where the employment or engagement of a medical practitioner is urgently needed and is not possible for the contractor to check the matters referred to in paragraph 48 in accordance with sub-paragraph (1)(b) before employing or engaging him he may be employed or engaged on a temporary basis for a single period of up to 7 days whilst such checks are undertaken.

    (3) Where the prospective employee is a GP Registrar, the requirements set out in sub-paragraph (1) shall apply with the modifications that -

(a) the name and address provided under sub-paragraph (1) may be the name and address of the Board on whose primary medical services performers list he has applied for inclusion; and

(b) confirmation that his name appears on those lists shall not be required until the end of the first two months of the Registrar's training period.

     53.  - (1) A contractor shall not employ or engage -

(a) a health care professional other than one to whom paragraph 48 applies unless the contractor has checked that he meets the requirements in paragraph 49; or

(b) a health care professional to perform clinical services unless he has taken reasonable steps to satisfy himself that he meets the requirements in paragraph 51.

    (2) Where the employment or engagement of a health care professional is urgently needed and it is not possible to check the matters referred to in paragraph 49 in accordance with sub-paragraph (1)(b) before employing or engaging him, he may be employed or engaged on a temporary basis for a single period of up to 7 days whilst such checks are undertaken.

    (3) When considering a health care professional's experience and training for the purposes of sub-paragraph (1)(b), the contractor shall have regard in particular to -

(a) any post-graduate or post-registration qualification held by the health care professional; and

(b) any relevant training undertaken by him and any relevant clinical experience gained by him.

     54.  - (1) The contractor shall not employ or engage a health care professional to perform medical services under the contract unless -

(a) that person has provided two clinical references, relating to two recent posts (which may include any current post) as a health care professional which lasted for three months without a significant break, or where this is not possible, a full explanation and alternative referees; and

(b) the contractor has checked and is satisfied with the references.

    (2) Where the employment or engagement of a health care professional is urgently needed and it is not possible to obtain and check the references in accordance with sub-paragraph (1)(b) before employing or engaging him, he may be employed or engaged on a temporary basis for a single period of up to 14 days whilst his references are checked and considered, and for an additional single period of a further 7 days if the contractor believes the person supplying those references is ill, on holiday or otherwise temporarily unavailable.

    (3) Where the contractor employs or engages the same person on more than one occasion within a period of three months, he may rely on the references provided on the first occasion, provided that those references are not more than twelve months old.

     55.  - (1) Before employing or engaging any person to assist him in the provision of services under the contract, the contractor shall take reasonable care to satisfy himself that the person in question is both suitably qualified and competent to discharge the duties for which he is to be employed or engaged.

    (2) The duty imposed by sub-paragraph (1) is in addition to the duties imposed by paragraphs 52 to 54.

    (3) When considering the competence and suitability of any person for the purpose of sub-paragraph (1), the contractor shall have regard, in particular, to -

(a) that person's academic and vocational qualifications;

(b) his education and training; and

(c) his previous employment or work experience.

Training
     56. The contractor shall ensure that for any health care professional who is -

(a) performing clinical services under the contract; or

(b) employed or engaged to assist in the performance of such services

there are in place arrangements for the purpose of maintaining and updating his skills and knowledge in relation to the services which he is performing or assisting in performing.

     57. The contractor shall afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee's competence.

Terms and conditions
     58. The contractor shall only offer employment to a general medical practitioner on terms and conditions which are no less favourable than those contained in the "Model terms and conditions of service for a salaried general practitioner employed by a GMS practice" published by the British Medical Association and the NHS Confederation as item 1.2 of the supplementary documents to the new GMS contract 2003[83].

Arrangements for GP Registrars
     59.  - (1) The contractor shall only employ a GP Registrar for the purpose of being trained by a GP Trainer with the agreement of the Department and subject to the conditions in sub-paragraph (2).

    (2) The conditions referred to in sub-paragraph (1) are that the contractor shall not, by reason only of having employed or engaged a GP Registrar, reduce the total number of hours for which other medical practitioners perform primary medical services under the contract or for which other staff assist them in the performance of those services.

    (3) A contractor which employs a GP Registrar shall -

(a) offer him terms of employment in accordance with the rates and subject to the conditions contained in any guidance given by the Department concerning the grants, fees, travelling and other allowances payable to GP Registrars; and

(b) take into account any guidance issued by the Department in relation to the GP Registrar Scheme.

Independent nurse prescribers and supplementary prescribers
     60.  - (1) Where -

(a) a contractor employs or engages a person who is an independent nurse prescriber or a supplementary prescriber whose functions will include prescribing;

(b) a party to the contract is an independent nurse prescriber or a supplementary prescriber whose functions will include prescribing; or

(c) the functions of a person who is an independent nurse prescriber or a supplementary prescriber whom the contractor already employs or has already engaged are extended to include prescribing,

it shall notify the Board in writing within the period of 7 days beginning with and including the date on which the contractor employed or engaged the person, the party became a party to the contract (unless, immediately before becoming such a party, he fell under paragraph (1)(a)) or the person's functions were extended, as the case may be.

    (2) Where -

(a) the contractor ceases to employ or engage a person who is an independent nurse prescriber or a supplementary prescriber whose functions included prescribing in his practice;

(b) the party to the contract who is an independent nurse prescriber or a supplementary prescriber whose functions include prescribing, ceases to be a party to the contract;

(c) the functions of a person who is an independent nurse prescriber or a supplementary prescriber whom the contractor employs or engages in his practice are changed so that they no longer include prescribing in his practice; or

(d) the contractor becomes aware that a person who is an independent nurse prescriber or a supplementary prescriber whom the contactor employs or engages has been removed or suspended from the relevant register,

he shall notify the Board in writing by the end of the second working day after the day when the event occurred.

    (3) The contractor shall provide the following information when he notifies the Board in accordance with sub-paragraph (1) -

(a) the person's full name;

(b) his professional qualifications;

(c) his identifying number which appears in the relevant register;

(d) the date on which his entry in the relevant register was annotated to the effect that he was qualified to order drugs, medicines and appliances for patients;

(e) the date on which -


(i) he was employed or engaged, if applicable,

(ii) he became a party to the agreement, if applicable, or

(iii) one of his functions became to prescribe in his practice.

    (4) The contractor shall provide the following information when he notifies the Board in accordance with sub-paragraph (2) -

(a) the person's full name;

(b) his professional qualifications;

(c) his identifying number which appears in the relevant register;

(d) the date -


(i) he ceased to be employed or engaged in his practice,

(ii) he ceased to be a party to the agreement,

(iii) his functions changed so as no longer to include prescribing, or

(iv) on which he was removed or suspended from the relevant register.

Signing of documents
     61.  - (1) In addition to any other requirements relating to such documents whether in these regulations or otherwise, the contractor shall ensure that the documents specified in paragraph (2) include -

(a) the clinical profession of the health care professional who signed the document; and

(b) the name of the contractor on whose behalf it is signed.

    (2) The documents referred to in sub-paragraph (1) are -

(a) certificates issued in accordance with regulation 21, unless regulations relating to particular certificates provide otherwise;

(b) prescription forms;

(c) any other clinical documents.

Level of skill
     62. The contractor shall carry out his obligations under the contract with reasonable care and skill.

Appraisal and assessment
     63.  - (1) The contractor shall ensure that any medical practitioner performing services under the contract -

(a) participates in the appraisal system provided by the Board, unless he participates in an appropriate appraisal system provided by another heath services body or is an armed forces GP; and

(b) co-operates with any assessment by or on behalf of the Board of services performed by that practitioner under the contract.

    (2) In sub-paragraph (1), "armed forces GP" means a medical practitioner who is employed on a contract of service by the Ministry of Defence, whether or not as a member of the United Kingdom Armed Forces of Her Majesty.

Sub-contracting of clinical matters
     64.  - (1) Subject to sub-paragraph (2), the contractor shall not sub-contract any of his rights or duties under the contract in relation to clinical matters unless -

(a) in all cases, including those which fall within paragraph 65,he has taken reasonable steps to satisfy himself that -


(i) it is reasonable in all the circumstances; and

(ii) that person is qualified and competent to provide the service; and



(b) except in cases which fall within paragraph 65, he has notified the Board in writing of his intention to sub-contract as soon as reasonably practicable before the date on which the proposed sub-contract is intended to come into operation.

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

    (3) The notification referred to in sub-paragraph (1)(b) shall include -

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

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

(c) the services to be covered; and

(d) the address of any premises to be used for the provision of services.

    (4) Following receipt of a notice in accordance with sub-paragraph (1)(b), the Board may request such further information relating to the proposed sub-contract as appears to it to be reasonable and the contractor shall supply such information promptly.

    (5) The contractor shall not proceed with the sub-contract or, if it has already taken effect, shall take appropriate steps to terminate it, where, within 28 days of receipt of the notice referred to in sub-paragraph (1)(b), the Board has served notice of objection to the sub-contract on the grounds that -

(a) the sub-contract would -


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

(ii) put the Board at risk of material financial loss; or



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

    (6) Where the Board objects to a proposed sub-contract in accordance with sub-paragraph (5), it shall include with the notice of objection a statement in writing of the reasons for its objection.

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

    (8) Where a Board does not object to a proposed sub-contract under paragraph (5), the parties to the contract shall be deemed to have agreed a variation of the contract which has the effect of adding to the list of practice premises any premises whose address was notified to it under sub-paragraph (3)(d) and paragraph 96(1) shall not apply.

    (9) A contract with a sub-contractor must prohibit the sub-contractor from sub-contracting the clinical services he has agreed with the contractor to provide.

Sub-contracting of out of hours services
     65.  - (1) A contractor shall not, otherwise than in accordance with the written approval of the Board, sub-contract all or part of his duty to provide out of hours services to any person other than those listed in sub-paragraph (2) other than on a short-term occasional basis.

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

(a) a person who holds a contract with a Board which includes out of hours services;

(b) an Article 15B provider who is required to provide the equivalent of essential services to his patients during all or part of the out of hours period;

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

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

    (3) An application for approval under sub-paragraph (1) shall be made by the contractor in writing to the Board and shall state -

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

(b) the address of any premises to be used for the provision of services;

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

(d) the services to be covered by the arrangement; and

(e) how it is proposed that the sub-contractor will meet the contractor's obligations under the contract in respect of the services covered by the arrangement.

    (4) Within 7 days of receipt of an application under sub-paragraph (3), a Board may request such further information relating to the proposed arrangements as seem to it to be reasonable.

    (5) Within 28 days of receipt of an application which meets the requirements specified in sub-paragraph (3) or the further information requested under sub-paragraph (4) (whichever is the later), the Board shall -

(a) approve the application;

(b) approve the application with conditions; or

(c) refuse the application.

    (6) The Board shall not refuse the application if it is satisfied that the proposed arrangement will, in respect of the services to be covered, enable the contractor to meet satisfactorily his obligations under the contract and will not -

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

(b) put the Board at risk of material financial loss.

    (7) The Board shall inform the contractor by notice in writing of its decision on the application and, where it refuses an application, it shall include in the notice a statement of the reasons for its refusal.

    (8) Where a Board approves an application under this paragraph the parties to the contract shall be deemed to have agreed a variation of the contract which has the effect of adding to the list of practice premises, for the purposes of the provision of services in accordance with that application, any premises whose address was notified to it under sub-paragraph (3)(b) and paragraph 96(1) shall not apply.

    (9) Sub-paragraphs (1) to (8) shall also apply in relation to any renewal or material variation of a sub-contract in relation to out of hours services.

    (10) A contract with a sub-contractor must prohibit the sub-contractor from sub-contracting the out of hours services it has agreed with the contractor to provide.

Withdrawal and variation of approval under paragraph 65
     66.  - (1) Without prejudice to any other remedies which it may have under the contract, where a Board has approved an application made under paragraph 65(3) it shall, subject to paragraph 67, be entitled to serve notice on the contractor withdrawing or varying that approval, from a date specified in the notice, if it is no longer satisfied that the proposed arrangement will enable the contractor to meet satisfactorily his obligations under the contract.

    (2) The date specified in the notice shall be such as appears reasonable in all the circumstances to the Board.

    (3) The notice referred to in sub-paragraph (1) shall take effect on whichever is the later of -

(a) the date specified in the notice; or

(b) (if applicable) the date of the final determination of the dispute resolution procedure (or any court proceedings) relating to the notice in favour of the Board.

     67.  - (1) Without prejudice to any other remedies which it may have under the contract, where a Board has approved an application made under paragraph 65(3) it shall be entitled to serve notice on the contractor withdrawing or varying that approval with immediate effect if -

(a) it is no longer satisfied that the proposed arrangement will enable the contractor to meet satisfactorily his obligations under the contract; and

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

    (2) An immediate withdrawal of approval under sub-paragraph (1) shall take effect on the date on which the notice referred to in that sub-paragraph is received by the contractor.

(a) the computer system upon which the contractor proposes to keep the records has been accredited by the Department or another person on its behalf in accordance with "General Medical Practice Computer Systems - Requirements for Accreditation - RFA99" version 1.0, 1.1 or 1.2 (DTS/Nurse Prescribing)[84];

(b) the security measures, audit and system management functions incorporated into the computer system as accredited in accordance with head (a) have been enabled; and

(c) the contractor is aware of, and has signed an undertaking that he will have regard to-


(i) any guidelines issued by the Department and notified in writing to the contractor by the Board; and

(ii) any document amending any guidelines referred to in (i), which has been notified to the contractor by the Board,



concerning good practice in the keeping of electronic patient records.

    (5) Where a patient's records are computerised records, the contractor shall, as soon as possible following a request from the Board, allow the Board to access the information recorded on the computer system on which those records are held by means of the audit function referred to in sub-paragraph (4)(b) to the extent necessary for the Board to confirm that the audit function is enabled and functioning correctly.

    (6) The contractor shall send the complete records relating to a patient to the Board -

(a) where a person on his list dies, before the end of the period of 14 days beginning with and including the date on which he was informed by the Board of the death, or (in any other case) before the end of the period of one month beginning with and including the date on which it learned of the death; or

(b) in any other case where the person is no longer registered with the contractor, as soon as possible at the request of the Board.

    (7) To the extent that a patient's records are computerised records, the contractor complies with sub-paragraph (6) if he sends to the Board a copy of those records -

(a) in written form; or

(b) with the written consent of the Board in any other form.

    (8) The consent of the Board to the transmission of information other than in written form for the purposes of sub-paragraph (7)(b) shall not be withheld or withdrawn provided it is satisfied, and continues to be satisfied, with the following matters -

(a) the contractor's proposals as to how the record will be transmitted;

(b) the contractor's proposals as to the format of the transmitted record;

(c) how the contractor will ensure that the record received by the Board is identical to that transmitted; and

(d) how a written copy of the record can be produced by the Board.

    (9) A contractor whose patient records are computerised records shall not disable, or attempt to disable, either the security measures, or the audit and system management functions referred to in sub-paragraph (4)(b).

Access to records for the purpose of the Quality Information Preparation Scheme
     69.  - (1) The contractor must provide access to his patient records on request to any appropriately qualified person with whom the Board has made arrangements for the provision of the Quality Information Preparation Scheme referred to in section 7 of the Statement of Financial Entitlements.

    (2) The contractor shall not be obliged to grant access to a person referred to in sub-paragraph (1) unless he produces, on request, written evidence that he is authorised by the Board to act on its behalf.

Confidentiality of personal data
     70. The contractor shall nominate a person with responsibility for practices and procedures relating to the confidentiality of personal data held by him.

Practice leaflet
     71. The contractor shall -

(a) compile a document (in this paragraph called a practice leaflet) which shall include the information specified in Schedule 7;

(b) review his practice leaflet at least once in every period of 12 months and make any amendments necessary to maintain its accuracy; and

(c) make available a copy of the leaflet, and any subsequent updates, to his patients and prospective patients.

Provision of information
     72.  - (1) Subject to sub-paragraph (2), the contractor shall, at the request of the Board produce to the Board or to a person authorised in writing by the Board or allow it, or a person authorised in writing by it, to access -

(a) any information which is reasonably required by the Board for the purposes of or in connection with the contract; and

(b) any other information which is reasonably required in connection with the Board's functions.

    (2) The contractor shall not be required to comply with any request made in accordance with sub-paragraph (1) unless it has been made by the Board in accordance with directions relating to the provision of information by contractors given to it by the Department under Article 17 of the Order.

Inquiries about prescriptions and referrals
     73.  - (1) The contractor shall, subject to sub-paragraphs (2) and (3), sufficiently answer any inquiries whether oral or in writing from the Board concerning -

(a) any prescription form issued by a prescriber;

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

(c) the referral by or on behalf of the contractor of any patient to any other services provided under the Order; or

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

    (2) An inquiry referred to in sub-paragraph (1) may only be made for the purpose either of obtaining information to assist the Board to discharge its functions or of assisting the contractor in the discharge of his obligations under the contract.

    (3) The contractor shall not be obliged to answer any inquiry referred to in sub-paragraph (1) unless it is made -

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

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

appointed in either case by the Board to assist it in the exercise of its functions under this paragraph and that person produces, on request, written evidence that he is authorised by the Board to make such an inquiry on its behalf.

Reports to a medical officer
     74.  - (1) The contractor shall, if he is satisfied that the patient consents -

(a) supply in writing to a medical officer within such reasonable period as that officer, or an officer of the Department for Social Development on his behalf and at his direction, may specify, such clinical information as the medical officer considers relevant about a patient to whom the contractor or a person acting on the contractor's behalf has issued or has refused to issue a medical certificate; and

(b) answer any inquiries by a medical officer, or by an officer of the Department for Social Development on his behalf and at his direction, about a prescription form or medical certificate issued by the contractor or on his behalf or about any statement which the contractor or a person acting on the contractor's behalf has made in a report.

    (2) For the purpose of satisfying himself that the patient has consented as required by paragraph (1), the contractor may (unless it has reason to believe the patient does not consent) rely on an assurance in writing from the medical officer, or any officer of the Department for Social Development, that he holds the patient's written consent.

Annual return and review
     75.  - (1) The contractor shall submit an annual return relating to the contract to the Board which shall require the same categories of information from all persons who hold contracts with that Board.

    (2) Following receipt of the return referred to in sub-paragraph (1), the Board shall arrange with the contractor an annual review of his performance in relation to the contract.

    (3) Either the contractor or the Board may, if they wishe to do so invite the Local Medical Committee participate in the annual review.

    (4) The Board shall prepare a draft record of the review referred to in sub-paragraph (2) for comment by the contractor and, having regard to such comments, shall produce a final written record of the review.

    (5) A copy of the final record referred to in sub-paragraph (4) shall be sent to the contractor.

Notifications to the Board
     76. In addition to any requirements of notification elsewhere in the regulations, the contractor shall notify the Board in writing, as soon as reasonably practicable, of -

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

(b) any circumstances which give rise to the Board's right to terminate the contract under paragraph 103, 104 or 105(1);

(c) any appointments system which he proposes to operate and the proposed discontinuance of any such system;

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

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

     77. The contractor shall, unless it is impracticable for him to do so, notify the Board in writing within 28 days of any occurrence requiring a change in the information about him published by the Board in accordance with regulations made under Article 56(3) of the Order[85].

     78. The contractor shall notify the Board in writing of any person other than a registered patient or a person whom he has accepted as a temporary resident to whom he has provided the essential services described in regulation 15(6) or (8) within the period of 28 days beginning on the day that the services were provided.

Notice provisions specific to a contract with a company limited by shares
     79.  - (1) A contractor which is a company limited by shares shall give notice in writing to the Board forthwith when -

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

(b) it passes a resolution or the High Court makes an order that the contractor be wound up;

(c) circumstances arise which might entitle a creditor or the High Court to appoint a receiver, administrator or administrative receiver for the contractor;

(d) circumstances arise which would enable the High Court to make a winding up order in respect of the contractor; or

(e) the contractor is unable to pay his debts within the meaning of Article 103 of the Insolvency (Northern Ireland) Order 1989[86].

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

(a) is a medical practitioner, or that he satisfies the conditions specified in Article 57B(2)(b)(i) to (iv) of the Order[87]; and

(b) meets the further conditions imposed on shareholders by virtue of regulations 4 and 5.

Notice provisions specific to a contract with two or more individuals practising in partnership
     80.  - (1) A contractor which is a partnership shall give notice in writing to the Board forthwith when -

(a) a partner leaves or informs his partners that he intends to leave the partnership, and the date upon which he left or will leave the partnership;

(b) a new partner joins the partnership.

    (2) A notice under sub-paragraph (1)(b) shall -

(a) state the date that the new partner joined the partnership;

(b) confirm that the new partner is a medical practitioner, or that he satisfies the conditions specified in Article 57B(2)(b)(i) to (iv) of the Order;

(c) confirm that the new partner meets the conditions imposed by regulations 4 and 5; and

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

Notification of deaths
     81.  - (1) The contractor shall report in writing to the Board the death on his practice premises of any patient no later than the end of the first working day after the date on which the death occurred.

    (2) The report shall include -

(a) the patient's full name;

(b) the patient's Central Health Index number or Health and Care number where known;

(c) the date and place of death;

(d) a brief description of the circumstances, as known, surrounding the death;

(e) the name of any medical practitioner or other person treating the patient whilst on the practice premises; and

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

    (3) The contractor shall send a copy of the report referred to in sub-paragraph (1) to any other Board in whose area the deceased was resident at the time of his death.

Notifications to patients following variation of the contract
     82. Where the contract is varied in accordance with Part 8 and, as a result of that variation -

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

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

the Board shall notify those patients in writing of the variation and its effect and inform them of the steps they can take to obtain elsewhere the services in question or, as the case may be, register elsewhere for the provision of essential services(or their equivalent).

Entry and inspection by the Board
     83.  - (1) Subject to the conditions in sub-paragraph (2), the contractor shall allow persons authorised in writing by the Board to enter and inspect the practice premises at any reasonable time.

    (2) The conditions referred to in sub-paragraph (1) are that -

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

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

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

    (3) Either the contractor or the Board may, if it wishes to do so, invite the Local Medical Committee for the area of the Board to be present at an inspection of the practice premises which takes place under this paragraph.

    (3) The contractor shall take reasonable steps to ensure that the complaints procedure is accessible to all patients.

Making of complaints
     85. A complaint may be made by or, with his consent, on behalf of a patient, or former patient, who is receiving or has received services under the contract, or -

(a) where the patient is a child -


(i) by either parent, or in the absence of both parents, the guardian or other adult who has care of the child,

(ii) by a person duly authorised by an authority looking after the child under the provisions of the Children (Northern Ireland) Order 1995[88]; or

(iii) by a person duly authorised by a voluntary organisation by which the child is being accommodated under the provisions of that Order;



(b) where the patient is incapable of making a complaint, by a relative or other adult who has an interest in his welfare.

     86. Where a patient has died a complaint may be made by a relative or other adult who had an interest in his welfare or, where the patient falls within paragraph 85(a)(ii) or (iii), by the Trust or voluntary organisation.

Period for making complaints
     87.  - (1) Subject to sub-paragraph (2), the period for making a complaint is -

(a) six months from the date on which the matter which is the subject of the complaint occurred; or

(b) six months from the date on which the matter which is the subject of the complaint comes to the complainant's notice provided that the complaint is made no later than 12 months after the date on which the matter which is the subject of the complaint occurred.

    (2) Where a complaint is not made during the period specified in sub-paragraph (1), it shall be referred to the person nominated under paragraph 88(2)(a) and if he is of the opinion that -

(a) having regard to all the circumstances of the case, it would have been unreasonable for the complainant to make the complaint within that period; and

(b) notwithstanding the time that has elapsed since the date on which the matter which is the subject matter of the complaint occurred, it is still possible to investigate the complaint properly,

the complaint shall be treated as if it had been received during the period specified in sub-paragraph (1).

Further requirements for complaints procedures
     88.  - (1) A complaints procedure shall also comply with the requirements set out in sub-paragraphs (2) to (6).

    (2) The contractor must nominate -

(a) a person (who need not be connected with the contractor and who, in the case of an individual, may be specified by his job title) to be responsible for the operation of the complaints procedure and the investigation of complaints; and

(b) a partner, or other senior person associated with the contractor, to be responsible for the effective management of the complaints procedure and for ensuring that action is taken in the light of the outcome of any investigation.

    (3) All complaints must be -

(a) either made or recorded in writing;

(b) acknowledged in writing within the period of three working days beginning with and including the day on which the complaint was made or, where that is not possible, as soon as reasonably practicable; and

(c) properly investigated.

    (4) Within the period of 10 working days beginning with and including the day on which the complaint was received by the person specified under sub-paragraph 2(a) or, where that is not possible, as soon as reasonably practicable, the complainant must be given a written summary of the investigation and its conclusions.

    (5) Where the investigation of the complaint requires consideration of the patient's medical records, the person specified under sub-paragraph 2(a) must inform the patient or person acting on his behalf if the investigation will involve disclosure of information contained in those records to a person other than the contractor or an employee of the contractor.

    (6) The contractor must keep a record of all complaints and copies of all correspondence relating to complaints, but such records must be kept separate from patients' medical records.

Co-operation with investigations
     89.  - (1) The contractor shall co-operate with -

(a) any investigation of a complaint in relation to any matter reasonably connected with the provision of services under the contract undertaken by -


(i) the Board, and

(ii) the Northern Ireland Commissioner for Complaints; and



(b) any investigation of a complaint by a health services body, an NHS body or local authority which relates to a patient or former patient of the contractor.

    (2) In sub-paragraph (1) -

"NHS body" means a Primary Care Trust, (in England and Wales and Scotland) an NHS Trust, an NHS foundation trust, a Strategic Health Authority, a Local Health Board, and a Health Board;

"local authority" means -

(a) any of the bodies listed in section 1 of the Local Authority Social Services Act 1970[89];

(b) the Council of the Isles of Scilly, or

(c) a council constituted under section 2 of the Local Government etc, (Scotland) Act 1994[90].

    (3) The co-operation required by sub-paragraph (1) includes -

(a) answering questions reasonably put to the contractor by the Board;

(b) providing any information relating to the complaint reasonably required by the Board ; and

(c) attending any meeting to consider the complaint (if held at a reasonably accessible place and at a reasonable hour, and due notice has been given) if the contractor's presence at the meeting is reasonably required by the Board.

Provision of information about complaints
     90. The contractor shall inform the Board, at such intervals as required, of the number of complaints it has received under the procedure established in accordance with this Part.

Dispute resolution procedure
     93.  - (1) Subject to sub-paragraph (2), the procedure specified in the following sub-paragraphs and paragraph 94 applies in the case of any dispute arising out of or in connection with the contract which is referred to the Department -

(a) in accordance with Article 8(4) of the 1991 Order (where the contract is a HSS contract); or

(b) in accordance with paragraph 92(1) (where the contract is not a HSS contract).

    (2) The procedure specified in this paragraph and paragraph 94 does not apply where a contractor refers a matter for determination in accordance with paragraph 36(1), and in such a case the procedure specified in that paragraph shall apply instead.

    (3) Any party wishing to refer a dispute as mentioned in sub-paragraph (1) shall send to the Department a written request for dispute resolution which shall include or be accompanied by -

(a) the names and addresses of the parties to the dispute;

(b) a copy of the contract; and

(c) a brief statement describing the nature and circumstances of the dispute.

    (4) Any party wishing to refer a dispute as mentioned in sub-paragraph (1) must send the request under sub-paragraph (3) within a period of three years beginning with and including the date on which the matter giving rise to the dispute happened or should reasonably have come to the attention of the party wishing to refer the dispute.

    (5) Where the dispute relates to a contract which is not a HSS contract, the Department may determine the matter itself or, if it considers it appropriate, appoint a person to consider and determine it[91].

    (6) Before reaching a decision as to who should determine the dispute, either under sub-paragraph (5) or under Article 8(5) of the 1991 Order, the Department shall, within the period of 7 days beginning with and including the date on which a matter was referred to it, send a written request to the parties to make in writing, within a specified period, any representations which they may wish to make about the matter.

    (7) The Department shall give, with the notice given under sub-paragraph (6), to the party other than the one which referred the matter to dispute resolution a copy of any document by which the matter was referred to dispute resolution.

    (8) The Department shall give a copy of any representations received from a party to the other party and shall in each case request (in writing) a party to whom a copy of the representations is given to make within a specified period any written observations which it wishes to make on those representations.

    (9) Following receipt of any representations from the parties or, if earlier, at the end of the period for making such representations specified in the request sent under sub-paragraph (6) or (8), the Department shall, if it decides to appoint a person to hear the dispute -

(a) inform the parties in writing of the name of the person or persons whom he has appointed; and

(b) pass to the person or persons so appointed any documents received from the parties under or pursuant to paragraphs (3), (6) or (8).

    (10) For the purpose of assisting him in his consideration of the matter, the adjudicator may -

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

(b) consult other persons whose expertise he considers will assist him in his consideration of the matter.

    (11) Where the adjudicator consults another person under sub-paragraph (10)(b), he shall notify the parties accordingly in writing and, where he considers that the interests of any party might be substantially affected by the result of the consultation, he shall give to the parties such opportunity as he considers reasonable in the circumstances to make observations on those results.

    (12) In considering the matter, the adjudicator shall consider -

(a) any written representations made in response to a request under sub-paragraph (6), but only if they are made within the specified period;

(b) any written observations made in response to a request under sub-paragraph (8), but only if they are made within the specified period;

(c) any oral representations made in response to an invitation under sub-paragraph (10)(a);

(d) the results of any consultation under sub-paragraph (10)(b); and

(e) any observations made in accordance with an opportunity given under sub-paragraph (11).

    (13) In this paragraph, "specified period" means such period as the Department shall specify in the request, being not less than 2, nor more than 4, weeks beginning with and including the date on which the notice referred to is given, but the Department may, if it considers that there is good reason for doing so, extend any such period (even after it has expired) and, where it does 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 94 and to any agreement by the parties, the adjudicator shall have wide discretion in determining the procedure of the dispute resolution to ensure the just, expeditious, economical and final determination of the dispute.

Determination of dispute
     94.  - (1) The adjudicator shall record his determination and the reasons for it, in writing and shall give notice of the determination (including the record of the reasons) to the parties.

    (2) In the case of a contract referred for determination in accordance with paragraph 92(1), sub-paragraph (9) of Article 8 of the 1991 Order shall apply as that sub-paragraph applies in the case of a contract referred for determination in accordance with sub-paragraph (4) of Article 8 of that Order.

    (3) In the case of a contract referred for determination in accordance with paragraph 92(1), sub-paragraph (5) of Article 57F of the Order shall apply as that subparagraph applies in the case of a contract referred for determination in accordance with sub-paragraph (4) of Article 8 of the 1991 Order.

Interpretation of Part 7
     95.  - (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 shall survive even where the contract has terminated.

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

Variation provisions specific to a contract with an individual medical practitioner
     97.  - (1) If a contractor which is an individual medical practitioner proposes to practise in partnership with a person during the existence of the contract, the contractor shall notify the Board in writing of -

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

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

    (2) A notice under sub-paragraph (1) shall in respect of the person with whom the contractor is proposing to practise in partnership, and also in respect of himself as regards the matters specified in head (c) -

(a) confirm that he is either -


(i) a medical practitioner, or

(ii) a person who satisfies the conditions specified in Article 57B(2)(b)(i) to (iv) of the Order[92];



(b) confirm that he is a person who satisfies the conditions imposed by regulations 4 and 5; and

(c) state whether or not it is to be a limited partnership, and if so, who is to be a limited and who a general partner,

and the notice shall be signed by the individual medical practitioner and by the person with whom he is proposing to practise in partnership.

    (3) The contractor shall ensure that any person who will practise in partnership with him is bound by the contract, whether by virtue of a partnership deed or otherwise.

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

    (5) Where it is reasonably practicable, the date specified by the Board pursuant to sub-paragraph (4) shall be 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 shall 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 Board pursuant to sub-paragraph (1), the Board -

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

(b) if it does propose to so vary the contract, it shall 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
     98.  - (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 shall only continue with 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 4(2)(a),

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

    (2) A contractor shall notify the Board in writing at least 28 days in advance of the date on which the contractor proposes to change his 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) shall -

(a) specify the date on which the contractor proposes to change his 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 will continue, which must be one of the partners; and

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

    (4) If a partnership is terminated or dissolved because, in a partnership consisting of two individuals practising in partnership, one of the partners has died, sub-paragraphs (1), (2) and (3) shall not apply and -

(a) the contract shall continue with the individual who has not died only if that individual is a medical practitioner who meets the condition in regulation 4(2)(a); and

(b) that individual shall in any event notify the Board in writing as soon as is reasonably practicable of the death of his partner.

    (5) When the Board receives a notice pursuant to sub-paragraph (2) or (4)(b), it shall acknowledge in writing receipt of the notice, and in relation to a notice served pursuant to sub-paragraph (2), the Board shall do so before the date specified pursuant to sub-paragraph (3)(a).

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

    (7) If the Board varies the contract pursuant to sub-paragraph (6), it shall notify the contractor in writing of the wording of the proposed variation and the date upon which that variation is to take effect.

Termination by agreement
     99. The Board and the contractor may agree in writing to terminate the contract, and if the parties so agree, they shall agree the date upon which that termination should take effect and any further terms upon which the contract should be terminated.

Termination by the contractor
     100.  - (1) A contractor may terminate the contract by serving notice in writing on the Board at any time.

    (2) Where a contractor serves notice pursuant to sub-paragraph (1), the contract shall, subject to sub-paragraph (3), terminate six 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 shall 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, sub-paragraph (2) shall apply to the contractor, save that the reference to " six months" shall instead be to "three months".

    (4) This paragraph and paragraph 101 are without prejudice to any other rights to terminate the contract that the contractor may have.

Late payment notices
     101.  - (1) The contractor may give notice in writing (a "late payment notice") to the Board if the Board has failed to make any payments due to the contractor in accordance with a term of the contract that has the effect specified in regulation 22, and the contractor shall specify in the late payment notice the payments that the 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 Board has still failed to make the payments due to the contractor, and that were specified in the late payment notice served on the Board pursuant to sub-paragraph (1).

    (3) If, following receipt of a late payment notice, the Board refers the matter to the 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 94 and that determination permits the contractor to terminate the contract; or

(b) the Board ceases to pursue the dispute resolution procedure,

whichever is the sooner.

Termination by the Board: general
     102. The Board may only terminate the contract in accordance with the provisions in this Part.

Termination by the Board for breach of conditions in regulation 4
     103.  - (1) The Board shall serve notice in writing on the contractor terminating the contract forthwith if the contractor is an individual medical practitioner and the medical practitioner no longer satisfies the condition specified in regulation 4(1).

    (2) Where the contractor is -

(a) two or more persons practising in partnership, and the condition specified in regulation 4(2)(a) is no longer satisfied; or

(b) a company limited by shares, and the condition specified in regulation 4(3)(a) is no longer satisfied,

sub-paragraph (3) shall apply.

    (3) Where sub-paragraph (2)(a) or (b) applies, the Board shall -

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

(b) serve notice in writing on the contractor confirming that the Board will allow the contract to continue, for a period specified by the Board of up to six months (the "interim period"), during which time the Board shall, with the consent of the contractor, employ or supply a general medical practitioner to the contractor for the interim period to assist the contractor in the provision of clinical services under the contract.

    (4) Before deciding which of the options in sub-paragraph (3) to pursue, the Board shall, whenever it is reasonably practicable to do so, consult the Local Medical Committee (if any) for its area.

    (5) If the contractor does not, pursuant to sub-paragraph (3)(b), consent to the Board employing or supplying a general medical practitioner during the interim period, the Board shall serve notice in writing on the contractor terminating the contract forthwith.

    (6) If, at the end of the interim period, the contractor still falls within sub-paragraph (2)(a) or (b), the Board shall serve notice in writing on the contractor terminating the contract forthwith.

Termination by the Board for the provision of untrue etc. information
     104. The Board may serve notice in writing on the contractor terminating the contract forthwith, 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 Board that written information provided to the Board by the contractor before the contract was entered into in relation to the conditions set out in regulation 4 and 5 (and compliance with those conditions) was, when given, untrue or inaccurate in a material respect.

Other grounds for termination by the Board
     105.  - (1) The Board may serve notice in writing on the contractor terminating the contract forthwith, or from such date as may be specified in the notice if -

(a) in the case of a contract with a medical practitioner, that medical practitioner;

(b) in the case of a contract with two or more individuals practising in partnership, any individual or the partnership; and

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


(i) the company,

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

(iii) any director or secretary of the company,



falls within sub-paragraph (2) during the existence of the contract.

    (2) A person falls within this sub-paragraph if -

(a) it does not satisfy the conditions prescribed in Article 57B(2)(b) or (3)(b) of the Order;

(b) he is the subject of a general or national disqualification;

(c) subject to sub-paragraph (3), he is 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 any licensing body anywhere in the world;

(d) subject to sub-paragraph (4), he has been dismissed (otherwise than by reason of redundancy) from any employment by a health services body unless before the Board has served a notice terminating the contract pursuant to this paragraph, he is employed by the health services body that dismissed him or by another health and social services body;

(e) he is disqualified from a primary medical services performers list unless his name has subsequently been included in such a list;

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

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

(h) subject to sub-paragraph (5), he has been convicted elsewhere of an offence which would if committed in Northern Ireland -


(i) constitute murder; or

(ii) constitute a criminal offence other than murder, and been sentenced to a term of imprisonment of over six months;



(i) he has been convicted of an offence referred to in Schedule 1 to the Children and Young Persons (Northern Ireland) Act 1968[93], Schedule 1 to the Children and Young Persons Act 1933[94] or Schedule 1 to the Criminal Procedure (Scotland) Act 1995[95];

(j) he has -



(i) been adjudged bankrupt or had sequestration of his estate awarded unless (in either case) he has been discharged or the bankruptcy order has been annulled,

(ii) been made the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986[96], unless that order has ceased to have effect or has been annulled,

(iii) made a composition or arrangement with, or granted a trust deed for, his creditors unless he has been discharged in respect of it,

(iv) been wound up under Part V of the Insolvency (Northern Ireland) Order 1989[97];



(k) there is -



(i) an administrator, administrative receiver or receiver appointed in respect of him, or

(ii) an administration order made in respect of him under Part III of the Insolvency (Northern Ireland) Order 1989;



(l) that person is a partnership and -



(i) 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;



(m) he has been -



(i) removed from the office of charity trustee or trustee for a charity by an order made by the Charity Commissioners or the High Court on the grounds of any misconduct or mismanagement in the administration of the charity for which he was responsible or to which he was privy, or which he by his conduct contributed to or facilitated, or

(ii) removed under section 7 of the Law Reform (Miscellaneous Provisions) (Scotland) Act 1990[98] (powers of the Court of Session to deal with management of charities), from being concerned in the management or control of any body;



(n) he is subject to a disqualification order under the Company Directors Disqualification (Northern Ireland) Order 2002[99], the Company Directors Disqualification Act 1986[100] or to an order made under section 429(2)(b) of the Insolvency Act 1986[101] (failure to pay under county court administration order);

(o) he has refused to comply with a request by the Board for him to be medically examined on the grounds that it is concerned that he is incapable of adequately providing services under the contract and, in a case where the contract is with two or more individuals practising in partnership or with a company, the Board is not satisfied that the contractor is taking adequate steps to deal with the matter.

    (3) A Board shall not terminate the contract pursuant to sub-paragraph (2)(c) where the 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 individuals practising in partnership; or

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


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

(ii) a director or secretary of the company,



as the case may be.

    (4) A Board shall not terminate the contract pursuant to sub-paragraph (2)(d) -

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

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

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

    (5) A Board shall not terminate the contract pursuant to sub-paragraph (2)(h) where the 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 individuals practising in partnership; or

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


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

(ii) a director or secretary of the company,



as the case may be.

     106. The 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 Board considers that the Board is at risk of material financial loss.

Termination by the Board: remedial notices and breach notices
     107.  - (1) Where a contractor has breached the contract other than as specified in paragraphs 103 to 106 and the breach is capable of remedy, the Board shall, 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 shall specify -

(a) details of the breach;

(b) the steps the contractor must take to the satisfaction of the 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 shall, unless the 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 Board is satisfied that the contractor has not taken the required steps to remedy the breach by the end of the notice period, the Board may terminate the contract with effect from such date as the Board may specify in a further notice to the contractor.

    (5) Where a contractor has breached the contract other than as specified in paragraphs 103 to 106 and the breach is not capable of remedy, the 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 Board may serve notice on the contractor terminating the contract with effect from such date as may be specified in that notice.

    (7) The Board shall 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 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 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 Board: additional provisions specific to contracts with two or more individuals practising in partnership and companies limited by shares
     108.  - (1) Where the contractor is a company limited by shares, if the Board becomes aware that the contractor is carrying on any business which the Board considers to be detrimental to the contractor's performance of his obligations under the contract -

(a) the Board shall be entitled to give notice to the contractor requiring that he ceases carrying on that business before the end of a period of not less than 28 days beginning on and including the day on which the notice is given ("the notice period"); and

(b) if the contractor has not satisfied the Board that he has ceased carrying on that business by the end of the notice period, the 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 Board shall be 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 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 Board to perform its obligations under the contract.

    (3) A notice given to the contractor pursuant to sub-paragraph (2) shall specify -

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

(b) the 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 Board to perform his obligations under the contract.

Contract sanctions
     109.  - (1) In this paragraph and paragraph 110, "contract sanction" means -

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

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

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

    (2) Where the Board is entitled to terminate the contract pursuant to paragraph 104, 105, 106 or 107(4) or (6) or paragraph 108, it may instead impose any of the contract sanctions if the Board is reasonably satisfied that the contract sanction to be imposed is appropriate and proportionate to the circumstances giving rise to the Board's entitlement to terminate the contract.

    (3) The Board shall not, under sub-paragraph (2), be entitled to impose any contract sanction that has the effect of terminating or suspending any obligation to provide, or any obligation that relates to, essential services.

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

    (5) Subject to paragraph 110, the Board shall not impose the contract sanction until at least 28 days after it has served notice on the contractor pursuant to sub-paragraph (4) unless the Board is satisfied that it is necessary to do so in order to -

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

(b) protect itself from material financial loss.

    (6) Where the Board imposes a contract sanction, the Board shall be entitled to charge the contractor the reasonable costs of additional administration that the Board has incurred in order to impose, or as a result of imposing, the contract sanction.

Contract sanctions and the dispute resolution procedure
     110.  - (1) If there is a dispute between the Board and the contractor in relation to a contract sanction that the Board is proposing to impose, the Board shall 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 dispute resolution procedure within 28 days beginning on and including the date on which the Board served notice on the contractor in accordance with paragraph 109(4) (or such longer period as may be agreed in writing with the Board), and notifies the Board in writing that he has done so, the Board shall not impose the contract sanction unless -

(a) there has been a determination of the dispute pursuant to paragraph 94 and that determination permits the Board to impose the contract sanction; or

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

whichever is the sooner.

    (3) If the contractor does not invoke the dispute resolution procedure within the time specified in sub-paragraph (2), the Board shall be entitled to impose the contract sanction forthwith.

    (4) If the Board is satisfied that it is necessary to impose the contract sanction before the 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 Board shall be entitled to impose the contract sanction forthwith, pending the outcome of that procedure.

Termination and the dispute resolution procedure
     111.  - (1) Where the Board is entitled to serve written notice on the contractor terminating the contract pursuant to paragraph 104, 105, 106, 107(4) or (6) or 108, the Board shall, 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 Board has served that notice on the contractor unless sub-paragraph (2) applies.

    (2) This sub-paragraph applies if the 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 with sub-paragraph (1), where the exceptions in sub-paragraph (2) do not apply, where the contractor invokes the dispute resolution procedure before the end of the period of notice referred to in sub-paragraph (1), and he notifies the Board in writing that he has done so, the contract shall not terminate at the end of the notice period but instead shall only terminate in the circumstances specified in sub-paragraph (4).

    (4) The contract shall only terminate if and when -

(a) there has been a determination of the dispute pursuant to paragraph 94 and that determination permits the Board to terminate the contract; or

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

whichever is the sooner.

    (5) If the Board is satisfied that it is necessary to terminate the contract before the 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) shall not apply and the Board shall be entitled to confirm, by written notice to be served on the contractor, that the contract will nevertheless terminate at the end of the period of the notice it served pursuant to paragraph 104, 105(1), 106, 107(4) or (6) or 108.

Consultation with the Local Medical Committee
     112.  - (1) Whenever the Board is considering -

(a) terminating the contract pursuant to paragraph 104, 105, 106, 107(4) or (6) or 108; or

(b) imposing a contract sanction,

it shall, whenever it is reasonably practicable to do so, consult the Local Medical Committee (if any) for its area before it terminates the contract or imposes a contract sanction.

    (2) Whether or not the Local Medical Committee has been consulted pursuant to sub-paragraph (1), whenever the Board imposes a contract sanction on a contractor or terminates a contract pursuant to this Part, it shall, 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).

     115. The contractor shall 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 insurance referred to in paragraph 114(1).

Gifts
     116.  - (1) The contractor shall 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 provides or wishes to provide services to the contractor or his patients in connection with the contract; and



(b) have, in his 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 -


(i) any person legally and 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 of a contractor (where the contractor is an individual medical practitioner) or of a person specified in paragraphs (b) to (e); or

any person (whether or not of the opposite sex) 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 husband and wife.

    (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.

    (4) The contractor shall take reasonable steps to ensure that he 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) shall include the following information -

(a) the name of the donor;

(b) in a case where the donor is a patient, the patient's Central Health Index number or Health and Care number or, if the number is not known, his 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 shall make the register available to the Board on request.

Compliance with legislation and guidance
     117. The contractor shall -

(a) comply with all relevant legislation; and

(b) have regard to all relevant guidance issued by the Board or the Department.

Third party rights
     118. The contract shall not create any right enforceable by any person not a party to it.

    (5) The person referred to in sub-paragraph (1) is any person who holds a contract with the Board which includes the provision of out of hours services.

    (6) A contractor may make more than one out of hours arrangement and may do so (for example) with different contractors or providers of primary medical services and in respect of different patients, different times and different parts of his practice area.

    (7) A contractor may retain responsibility for, or make separate out of hours arrangements in respect of, the provision to any patients of maternity medical services during the out of hours period which the contractor is required to provide pursuant to regulation 30 or 31 and any separate out of hours arrangements he makes may encompass all or any part of the maternity medical services he provides.

    (8) Nothing in this paragraph prevents a contractor from retaining or resuming his obligations in relation to named patients.

Application for approval of an out of hours arrangement
     2.  - (1) An application to the Board for approval of an out of hours arrangement shall be made in writing and shall state -

(a) the name and address of the proposed transferee out of hours services provider;

(b) the periods during which the contractor's obligations under the contract are to be transferred;

(c) how the proposed transferee out of hours services provider intends to meet the contractor's obligations during the periods specified under paragraph (b);

(d) the arrangements for the transfer of the contractor's obligations under the contract to and from the transferee out of hours services provider at the beginning and end of the periods specified under head (b);

(e) whether the proposed arrangement includes the contractor's obligations in respect of maternity medical services; and

(f) how long the proposed arrangements are intended to last and the circumstances in which the contractor's obligations under the contract during the periods specified under head (b) would revert to it.

    (2) The Board shall determine the application before the end of the period of 28 days beginning with and including the day on which the Board received it.

    (3) The Board shall grant approval to a proposed out of hours arrangement if it is satisfied -

(a) having regard to the overall provision of primary medical services provided in the out of hours period in its area, that the arrangement is reasonable and will contribute to the efficient provision of such services in the area;

(b) having regard, in particular, to the interests of the contractor's patients, that the arrangement is reasonable;

(c) having regard, in particular, to all reasonably foreseeable circumstances, that the arrangement is practicable and will work satisfactorily;

(d) that it will be clear to the contractor's patients how to seek primary medical services during the out of hours period;

(e) where maternity medical services are to be provided under the out of hours arrangement, that they will be performed by a medical practitioner who has such medical experience and training as are necessary to enable the medical practitioner properly to perform such services; and

(f) that if the arrangement comes to an end, the contractor has in place proper arrangements for the immediate resumption of the contractor's responsibilities,

and shall not refuse to grant approval without first consulting the Local Medical Committee (if any) for its area.

    (4) The Board shall give notice to the contractor of its determination and, where it refuses an application, it shall send the contractor a statement in writing of the reasons for its determination.

    (5) A contractor which wishes to refer the matter in accordance with the dispute resolution procedure must do so before the end of the period of 30 days beginning with and including the day on which the Board's notification under sub-paragraph (4) was sent.

Effect of approval of an arrangement with a transferee out of hours services provider
     3. Where the Board has approved an out of hours arrangement with a transferee out of hours services provider, the Board and the transferee out of hours services provider shall be deemed to have agreed a variation of their contract which has the effect of including in it, from the date on which the out of hours arrangement commences, and for so long as that arrangement continues, the services covered by that arrangement and paragraph 96(1) of Schedule 5 shall not apply.

Review of approval
     4.  - (1) Where it appears to the Board that it may no longer be satisfied of any of the matters referred to in paragraph 2(3), it may give notice to the contractor that it proposes to review its approval of the out of hours arrangement.

    (2) On any review under sub-paragraph (1), the Board shall allow the contractor a period of 30 days, beginning with and including the day on which it sent the notice, within which to make representations in writing to the Board.

    (3) After considering any representations made in accordance with sub-paragraph (2), the Board may determine to -

(a) continue its approval;

(b) withdraw its approval following a period of notice; or

(c) if it appears to it that it is necessary in the interests of the contractor's patients, withdraw its approval immediately.

    (4) Except in the case of an immediate withdrawal of approval, the Board shall not withdraw its approval without first consulting the Local Medical Committee (if any) for its area.

    (5) Where the Board determines to withdraw its approval immediately, it shall notify the Local Medical Committee (if any) for its area.

    (6) The Board shall give notice to the contractor of its determination under sub-paragraph (3).

    (7) Where the Board withdraws its approval, whether immediately or on notice, it shall include with the notice a statement in writing of the reasons for its determination.

    (8) A contractor which wishes to refer the matter in accordance with the dispute resolution procedure must do so before the end of the period of 30 days beginning with and including the day on which the Board's notification under sub-paragraph (6) was sent.

    (9) Where the Board determines to withdraw its approval following a period of notice, the withdrawal shall take effect at the end of the period of two months beginning with and including -

(a) the date on which the notice referred to in sub-paragraph (6) was sent; or

(b) where there has been a dispute which has been referred under the dispute resolution procedure and the dispute is determined in favour of withdrawal, the date on which the contractor receives notice of the determination.

    (10) Where the Board determines to withdraw its approval immediately, the withdrawal shall take effect on the day on which the notice referred to in sub-paragraph (6) is received by the contractor.

Immediate withdrawal of approval other than following review
     5.  - (1) The Board shall withdraw its approval of an out of hours arrangement immediately -

(a) in the case of an arrangement with a person specified in paragraph 1(5), if the person with whom it is made ceases to hold a contract with the Board which includes the provision of out of hours services; or

(b) where, without any review having taken place under paragraph 4, it appears to the Board that it is necessary in the interests of the contractor's patients to withdraw its approval immediately.

    (2) The Board shall give notice to the contractor of a withdrawal of approval under sub-paragraph (1)(a) or (b) and shall include with the notice a statement in writing of the reasons for its determination.

    (3) An immediate withdrawal of approval under sub-paragraph (1) shall take effect on the day on which the notice referred to in sub-paragraph (2) is received by the contractor.

    (4) The Board shall notify the Local Medical Committee (if any) for its area of a withdrawal of approval under sub-paragraph (1)(b).

    (5) A contractor which wishes to refer a withdrawal of approval under sub-paragraph (1)(b) in accordance with the dispute resolution procedure must do so before the end of the period of 30 days beginning with and including the day on which the Board's notification under sub-paragraph (2) was sent.

Termination of an out of hours arrangement
     6. The contractor shall terminate an out of hours arrangement made under paragraph 1(2) with effect from the date of the taking effect of the withdrawal of the Board's approval of that arrangement under paragraph 4 or 5.

[2] S.I. 1972/1265 (N.I. 14), Article 15C(1)(b)(iii) was inserted by Article 6 of the Primary Medical Services (Northern Ireland) Order 2004 (" the 2004 Order"); Articles 57A, 57B, 57E and 57F were inserted by Article 4 of that Order and Article 55B was inserted by paragraph 9 of Schedule 1 to that Orderback

[3] S.I. 1991/194 (N.I. 1)back

[4] 1983 c. 54; section 11(4) was amended by the National Health Service (Primary Care) Act 1997 (c.46), section 35(4) and Schedule 2, paragraph 61(2)back

[5] Definition inserted by Schedule 2 to S.I. 1997/1177 (N.I. 7)back

[6] 1968 c. 67; section 69 was amended by the Statute Law (Repeals) Act 1993 (c. 50) and the Pharmacists (Fitness to Practise) Act 1997 (c. 19), Schedule 5, paragraph 5back

[7] Schedule 11 is substituted by Schedule 2 to the Health and Personal Social Services Act (Northern Ireland) 2001 c. 3 (N.I.)back

[8] S.I. 1978/1907 (N.I. 26)back

[9] 1977 c. 49back

[10] 1978 c. 29back

[11] S.R. 1998 No. 13back

[12] 1978 c. 29back

[13] S.I. 1995/755 (N.I. 2)back

[14] 1968 c. 67.back

[15] 1907 c. 24back

[16] Section 16BA is inserted by section 6 of the National Health Service Reform and Health Care Professions Act 2002 c. 17back

[17] Article 55B was inserted into the Order by paragraph 9 of Schedule 1 to the 2004 Orderback

[18] 1983 c. 54; section 2 was amended by S.I. 1996/1591 and 2002/3135back

[19] 1973 c. 36back

[20] 2003 c. 43back

[21] 1990 c. 19back

[22] S.I. 2003/253back

[23] S.I. 2003/1250back

[24] S.R. 1997 No. 381back

[25] S.I. 1997/1830 as amended by S.I. 1997/2044, 1998/108, 1178 and 2081, 1999/1044 and 3463, 2000/1917, 2889 and 3231, 2001/2777, 2889 and 3942, 2002/549 and 2469 and 2003/696.(24) Article 57G was inserted by Article 8 of the 2004 Orderback

[26] 1977 c. 49; section 16A was inserted by the Health Act 1999 (c. 8), section 2(1)back

[27] S.I. 1992/3204 (N.I. 20)back

[28] 1954 c. 61.back

[29] S.I. 1976/1213 (N.I. 22)back

[30] Article 57C was inserted into the Order by Article 4 of the 2004 Orderback

[31] Section 8 was substituted by section 1 of the National Health Service Reform and Health Care Professions Act 2002 c. 17back

[32] Article 57D was inserted into the Order by Article 4 of the 2004 Orderback

[33] Schedule 11 was substituted by Schedule 2 to the Health and Personal Social Services (Northern Ireland) Order 2001 (c. 3)back

[34] S.I. 2004/311 (N.I. 2)back

[35] c. 34 (N.I)back

[36] 1933 c. 12 as amended by the Criminal Justice Act 1988 (1988 c. 33), section 170, Schedule 15, paragraph 8 and Schedule 16, paragraph 16; Sexual Offences Act 1956 (1956 c. 69), sections 48 and 51 and Schedule 3 and as modified by the Criminal Justice Act 1988, section 170(1), Schedule 15, paragraph 9back

[37] 1995 c. 46back

[38] 1986 c. 45. Schedule 4A was inserted by section 257 of and Schedule 20 to the Enterprise Act 2002 (c. 40)back

[39] 1990 c. 40back

[40] S.I. 2002/3150 (N.I. 4)back

[41] S.I. 1986/1032 (N.I. 6)back

[42] Article 15C(b)(iii) was inserted into the Order by Article 6 of the 2004 Actback

[43] World Health Organisation, 1992 ISBN 92 4 1544 19 8 (v. I) NLM Classification: WB 15back

[44] S.R. 1976 No. 175. Regulation 2 is amended by S.R. 1982 No. 153, S.R. 1987 No. 117, S.R. 1992 No. 83, S.R. 1994. No 468 and S.R. 1995 No. 149back

[45] Article 57C was inserted into the Order by Article 4 of the 2004 Orderback

[46] Article 55B was inserted into the Order by paragraph 9 of Schedule 1 to the 2004 Orderback

[47] S.R. 1997 No. 380back

[48] S.R. 1997 No. 380back

[49] David Hall and David Elliman, January 2003, Oxford University Press, ISBN 0-19-85188-Xback

[50] 28 & 29 Vict. c. 73.back

[51] 2 &3 Geo. 6 c. 83back

[52] 2 &3 Geo. 6 c. 83back

[53] 2 & 3 Geo. 6 c. 82back

[54] 5 & 6 Geo. 6 c. 26back

[55] 10 & 11 Geo. 6 c. 19back

[56] 1992 c. 8back

[57] 1992 c. 7back

[58] S.I. 1988/594 (N.I. 2); Article 13 is amended by Schedule 7 to the Social Security (Northern Ireland) Order 1990 (S.I. 1990/1511 (N.I. 15)) and by paragraph 35(1) and (2) of Schedule 2 to the Social Security (Consequential Provisions) (Northern Ireland) Act 1992 (c. 9)back

[59] S.I. 1976/1041 (N.I. 14) as amended by the Still-Birth (Definition) (Northern Ireland) Order 1992 (S.I. 1992/1310 (N.I. 10))back

[60] S.I. 1986/595 (N.I. 4)back

[61] S.I. 1996/1141 (N.I. 6)back

[62] 1985 c. 17back

[63] 1980 c. 9back

[64] 1996 c. 14back

[65] 1985 c. 50back

[66] S.I. 1982/1135back

[67] S.I. 1985/454 substituted by Schedule 2 to S.I. 1987/168back

[68] 1972 (N.I. 14)back

[69] S.R. 2002/1back

[70] 1971 c. 38back

[71] Schedule 4 was amended by S.R. 2003/314back

[72] Article 57D was inserted into the Order by Article 4 of the 2004 Orderback

[73] Article 3B was inserted into the POM Order by S.I. 2003/696back

[74] Article 57D was inserted into the Order by Article 4 of the 2004 Orderback

[75] 1968 c. 67back

[76] 1972 c. 68back

[77] O.J. No. L311, 28.11.2001, p. 67back

[78] Regulation 12 was amended by S.R. 2001/222back

[79] Article 57D was inserted into the Order by Article 4 of the 2004 Orderback

[80] 1968 c. 67back

[81] 1983 c. 54; section 41A was inserted by S.I. 2000/1803back

[82] 1983 c. 54; section 15A was inserted by regulations 2 and 3 of S.I. 2000/3041back

[83] This document is published jointly by the General Practitioners Committee of the British Medical Association and the NHS Confederation. It is available on the Confederation's website at www.nhsconfed.org or a copy may be obtained by writing to the NHS Confederation, 1 Warwick Row, London, SW1E 5ERback

[84] RFA99 is published by the NHS Information Authority. Version 1.0 was published in October 1999 and version 1.2 (DTS/Nursing Prescribing) in August 2003. Copies are available on the NHS Information Authority's website at www.nhsia.uk/sat/specification/pages. Copies may be obtained by writing to the NHS Information Authority, Systems Accreditation and Testing team, Aqueous 2, Aston Cross, Rocky Lane, Birmingham B6 5RQback

[85] Article 56 was inserted into the Order by Article 3 of the 2004 Orderback

[86] S.I. 1986 c. 45back

[87] Article 57B was inserted into the Order by Article 4 of the 2004 Orderback

[88] S.I. 1995/755 (N.I. 2)back

[89] 1970 c. 42; section 1 was amended by the Local Government Act 1972 (c. 70), section 195 and by the Local Government (Wales) Act 1994 (c. 19), Schedule 10, paragraph 7back

[90] 1994 c. 39back

[91] Where the dispute relates to a contract which is a HSS contract, Article 8(4) of the 1991 Order appliesback

[92] Article 57 was inserted into the Order by Article 4 of the 2004 Orderback

[93] c. 34 (N.I)back

[94] 1933 c 12 as amended by the Criminal Justice Act 1988 (1988 c. 33), section 170, Schedule 15, paragraph 8 and Schedule 16, paragraph 16; Sexual Offences Act 1956 (1956 c. 69), sections 48 and 51 and Schedule 3 and as modified by the Criminal Justice Act 1988, section 170(1), Schedule 15, paragraph 9back

[95] 1995 c. 46back

[96] 1986 c. 45. Schedule 4A was inserted by section 257 of and Schedule 2 to the Enterprise Act 2002 (c. 40)back

[97] S.I. 1989/2405 (N.I. 19)back

[98] 1990 c. 40back

[99] S.I. 2002/3150 (N.I. 4)back

[100] 1986 c. 46 as amended by the Insolvency Act 2000 (2000 c. 39)back

[101] 1986 c. 45back

  © Crown copyright 2004