Statutory Instruments of the Scottish Parliament

"the 1978 Act" means the National Health Service (Scotland) Act 1978;

"an agreement" means an agreement made between a Health Board and a provider pursuant to section 17C of the 1978 Act under which personal medical services are provided;

(a) the right of any person in the Health Board's area to choose the medical practitioner from whom that person is to receive medical services; or

(b) the scope of the Health Board to require a person to be assigned to a performer's list,

(a) a performer's list in respect of each performer who is, under an agreement, to have such a list; and

(b) if, in accordance with an agreement, there is to be a pooled list, that list.

(a) upon withdrawal from an agreement pursuant to regulation 4; or

(b) upon termination of an agreement; or

(c) upon that person or body giving notice in writing to the Scottish Ministers and to the Health Board with which an agreement has been entered into or is to be entered into that they have decided to cease to be a health service body.

(a) persons included in any performer's list;

(b) persons included in a pooled list operated under the agreement;

(c) persons accepted for inclusion in a list referred to in sub-paragraphs (a) or (b);

(d) for the limited period specified in paragraph 8 of Schedule 3, persons who have been refused acceptance for inclusion in a list referred to in sub-paragraphs (a) or (b) of this paragraph;

(e) persons who have been assigned to a performer by a provider under regulation 5 of the Choice of Medical Practitioner Regulations;

(f) persons for whom the provider is obliged to provide personal medical services under regulation 5(6) of the Choice of Medical Practitioner Regulations, having been unable to assign them to a performer;

(g) persons accepted as temporary residents by a performer or the provider under the agreement;

(h) persons who would be eligible under the agreement for acceptance by a performer or the provider as temporary residents and to whom a performer has agreed to provide an immunisation;

(i) persons who would be eligible under the agreement for acceptance by a performer or the provider as temporary residents and for whom a performer or the provider has agreed to provide maternity medical services or contraceptive services, or in respect of whom a performer has agreed to take a cervical smear;

(j) for the limited period specified in paragraph 8 of Schedule 3, persons to whom a performer is required by virtue of sub-paragraphs (b) and (c) of that paragraph to give treatment which is immediately required;

(k) persons by whom a performer is requested and agrees, in connection with his performance of personal medical services under the agreement, to give treatment which is immediately required owing to an accident or other emergency at any place in the area of the Health Board, provided that-


(i) there is no registered medical practitioner who, at the time of the request, is under an obligation (otherwise than by virtue of this paragraph or his terms of service) to give treatment to that person; or

(ii) there is such a registered medical practitioner but, after being requested to attend, that practitioner is unable to attend and give treatment immediately required; or

(iii) in the case of a performer, more than one such performer is under an obligation to give treatment and no such performer practising from the premises to which the request was made is able to attend and give treatment;



(l) in respect of child health surveillance services, minor surgery services, contraceptive services or maternity medical services, persons for whom a performer has undertaken to perform such services.

Provision of personal medical services and other services
     3. An agreement shall require the provision of personal medical services which are-

(a) equivalent in scope (though not necessarily identical in detail) to general medical services; and

(b) available to patients throughout each period of 24 hours during which the agreement remains in existence.

     4. Sub-paragraph (a) of paragraph 3 is not to be construed as requiring an agreement to include the provision of child health surveillance services, contraceptive services, minor surgery services or, except in an emergency, maternity medical services.

     5. Where a provider is to provide child health surveillance services, minor surgery services or both services under an agreement, the Health Board must ensure that the provider is authorised by the agreement to make arrangements for such of those services as are to be provided under the agreement, to be provided to any person who applies for them and who is a personal medical services patient in relation to any other agreement.

     6. Where a provider is to provide maternity medical services, contraceptive services or both services under an agreement, the Health Board must ensure that the provider is authorised by the agreement to make arrangements for such of those services as are to be provided under the agreement to be provided to any person who applies for them.

     7. Where an agreement imposes requirements in accordance with paragraph 5 or 6, the agreement shall contain terms as to the arrangements for a person to apply for the provision of such a service, and as to the arrangements under which the provider may terminate his responsibility for the provision of that service.

     8. An agreement shall require the provider to take reasonable steps to ensure the continuity of a patient's treatment.

     9. An agreement shall provide that unless the provider has the consent of the Health Board, a performer must not perform personal medical services at any premises if he would have required the consent of the Health Board to carry on practice from those premises, if he were providing general medical services.

Provision of drugs or appliances for immediate treatment
     10. An agreement shall-

(a) require the provider to provide to a patient any appliance or drug, 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) allow the provider to provide to a patient any appliance or drug, not being a Scheduled drug, which a performer administers or applies to that patient,

and the services which are provided in accordance with this paragraph must be available to patients throughout each period of 24 hours during which the agreement remains in existence.

Performance of personal medical services
     11. An agreement shall-

(a) require that all performers who are primarily responsible for the performance of personal medical services (and not just a particular aspect of personal medical services) in respect of the patients have a performer's list, whether or not they also participate in arrangements for a pooled list in connection with the agreement;

(b) name each of the performers who will under the agreement be primarily responsible for the performance of personal medical services, or any particular aspect of personal medical services, in respect of the patients;

(c) specify in respect of each of the performers who are named in the agreement in accordance with sub-paragraph (b)-


(i) the services which that person is to perform under the agreement, including whether that person is to perform child health surveillance services, contraceptive services, minor surgery services or maternity medical services and, if so, which of them;

(ii) if that person is not the provider, the nature of that person's legal relationship with the provider; and

(iii) whether that person is to have a performer's list and, if so, whether that person is also to participate in any arrangements for a pooled list; and



(d) specify the circumstances in which personal medical services, or any aspect of personal medical services, will be performed by a person other than a performer who is primarily responsible for the performance of those services.

Persons employed or engaged by a provider
     12. An agreement shall require that a provider shall-

(a) before employing or engaging any person other than a registered medical practitioner to assist the provider in the provision of personal medical services, take reasonable care to become satisfied that the person in question is both suitably qualified and competent to discharge the duties for which that person is to be employed or engaged, having regard, in particular, to that person's academic and vocational qualifications and training and experience in employment; and

(b) afford to each employee or person engaged reasonable opportunities to undertake appropriate training with a view to maintaining that person's competence.

Medical practitioners with provisional registration
     13. An agreement shall require that the provider shall not, by virtue only of having employed or engaged a person who is provisionally registered under section 15 or 21 of the Medical Act 1983 and who is acting in the course of his employment in an approved medical practice, reduce the total number of hours for which other performers perform personal medical services in connection with the agreement, or for which other staff assist them in the performance of personal medical services.

Performer's lists and pooled lists
     14. An agreement shall require the provider to supply to the Health Board such information about the performers as it requires for the purpose of preparing patient's lists and keeping them up to date, in accordance with regulation 9.

     15. An agreement shall specify the maximum total number of persons who may be included in the performer's lists of each of the performers or, if a pooled list is to be operated, the maximum total number of persons who may be included in the performer's lists and the pooled list.

     16. Where an agreement authorises a pooled list, it shall provide that the provider shall be responsible for accepting a person for inclusion in that list and may do so only if the person is eligible for the provision of personal medical services under the agreement.

     17. An agreement shall require the provider to ensure that no person is accepted for inclusion in more than one performer's list, or for inclusion in both a performer's list and a pooled list.

     18. The provider shall be required by an agreement to give the Health Board not less than one month's notice of the provider's intention to cease to operate a pooled list.

Assignment of patients to performers
     19. An agreement shall require the provider to assign a person to a performer in accordance with regulation 5 of the Choice of Medical Practitioner Regulations if required to do so by the Health Board under regulation 4(2)(b) of those Regulations.

Acceptance of patients in a performer's list
     20.  - (1) An agreement shall require that where a performer has agreed to accept a person for inclusion in a performer's list, that performer shall, within 14 days of receiving that person's medical card or, as the case may be, form of application, or as soon after the expiry of that period as is practicable-

(a) sign the medical card or, as the case may be, form of application; and

(b) send it to the Health Board.

    (2) An agreement shall require that where, for the purposes of sub-paragraph (1), any person signs a medical card or form of application on behalf of the performer, the performer shall ensure that the signatory specifies the name of the provider on whose behalf that person is signing.

Acceptance of patients in a pooled list
     21.  - (1) Where an agreement authorises the operation of a pooled list it shall comply with the following provisions of this paragraph.

    (2) An agreement shall require the provider to have a procedure under which persons may apply for inclusion in a pooled list, which provides that-

(a) in the case of a medical practitioner performing child health surveillance services or minor surgery services, that which any general medical practitioner included, under the GMS Regulations, in the child health surveillance list or, as the case may be, the minor surgery list, may reasonably be expected to exercise; and

(b) in any other case, that which general medical practitioners as a class may reasonably be expected to exercise.

Availability of personal medical services and other services
     4.  - (1) All necessary and appropriate personal medical services of the type usually provided by general medical practitioners shall be performed in respect of the patients receiving personal medical services under an agreement, including the following:-

(a) giving advice, where appropriate, to a patient in connection with the patient's general health, and in particular about the significance of diet, exercise, the use of tobacco, the consumption of alcohol and the misuse of drugs or solvents;

(b) offering to patients consultations and, where appropriate, physical examinations for the purpose of identifying, or reducing the risk of, disease or injury;

(c) offering to patients appropriate immunisations;

(d) arranging for the referral of patients, as appropriate, for the provision of any other services under the 1978 Act;

(e) giving advice, as appropriate, to enable patients to avail themselves of social work services provided by a local authority; and

(f) providing a cervical smear test-


(i) upon request to all patients who are women aged 21 to 60 (who have a cervix) at intervals of no more than five and a half years; and

(ii) at such shorter intervals as may be appropriate to all patients in respect of whom the need for a cervical smear test is indicated by the result of a previous test or other treatment.

    (2) Nothing in this Schedule prevents a performer from-

(a) arranging for the referral of a patient pursuant to paragraph (d) of sub-paragraph (1) without first seeing the patient, in a case where the medical condition of the patient makes that course of action appropriate; or

(b) visiting the patient in circumstances where the agreement does not place the performer under an obligation to do so.

     5. In normal hours, personal medical services shall be performed-

(a) at the normal place; or

(b) in the case of a patient whose condition is such that, in the reasonable opinion of the performer from whom treatment is requested, it would be inappropriate for the patient to attend at the normal place, at the place where the patient is at that time residing or, at some other appropriate place.

     6. Outside normal hours, if, in the light of a patient's medical condition, it is the reasonable opinion of the performer from whom treatment is requested that a consultation is needed before the next time at which the patient could be seen during normal hours, personal medical services shall be performed-

(a) at the normal place;

(b) at the out of hours place; or

(c) in the case of a patient whose condition is such that, in the reasonable opinion of the performer from whom treatment is requested, it would be inappropriate for the patient to attend either at the normal place or at the out of hours place, at the place where the patient is at that time residing or, at some other appropriate place.

     7. Appropriate treatment which is immediately required owing to an accident or emergency at any place in the practice area shall be given (upon the request of any person) to any person.

     8. Immediately necessary treatment shall be given, upon request, to any person-

(a) who lives in the practice area, has been refused acceptance as a personal medical services patient, and is not the patient of another medical practitioner practising in that area;

(b) to whom regulation 7 of the Choice of Medical Practitioner Regulations or paragraph 23(a) of Schedule 1 applies but who has been refused acceptance by a performer or the provider as a temporary resident; or

(c) in respect of whom a request has been made that that person should cease to be a personal medical services patient with immediate effect in accordance with paragraph 22(b) of Schedule 1,

until the expiry of the period of 14 days beginning with the date when that person was refused acceptance (or, as the case may be, with the date when the request that that person should no longer be a personal medical services patient was made), or until that person has been accepted by or assigned to another medical practitioner, or accepted by another provider, whichever occurs first.

     9. Where a person applies to a performer for treatment and claims to be on the performer's list of that performer or on the pooled list (if any), but fails to produce their medical card on request and the performer from whom treatment is requested has reasonable doubts about that person's claim, any necessary treatment shall nevertheless be given to that person.

     10. Maternity medical services shall be performed in the event of a summons to an obstetric emergency even if the performer from whom treatment is requested has not been approved by a Health Board in accordance with regulation 8(3).

Responsibility for performance of personal medical services
     11.  - (1) Personal medical services shall be performed by those performers named in an agreement as being primarily responsible for the performance of those services in respect of the patients, except in the circumstances specified in an agreement in accordance with paragraph 11(d) of Schedule 1 when, subject to sub-paragraphs (2) and (3), the services may be performed by another medical practitioner.

    (2) Child health surveillance services and minor surgery services may be performed only by a performer about whom a Health Board has satisfied itself in accordance with regulation 8(1) or, as the case may be 8(3).

    (3) Where it is clinically reasonable in the circumstances to delegate a task or duty connected with the performance of personal medical services to someone other than a performer, that task or duty may be delegated by a performer to a person whom that performer is satisfied is competent to undertake that task or duty (but clinical responsibility for the performance of personal medical services will remain with the performer).

Medical certificates
     12. A patient or his personal representatives shall be issued, free of charge, any medical certificate of a description prescribed in column 1 of Schedule 9 to the GMS Regulations which is reasonably required under or for the purposes of the enactments specified in relation to that 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 performer who is not a performer in relation to the agreement in question; or

(b) is not being treated by, or under the supervision of, a performer.

     13.  - (1) A medical officer, or an officer of the Department of Social Security acting on behalf of and at the direction of that medical officer, shall, if a performer is satisfied that the patient consents, be provided on request-

(a) in writing and within such reasonable period as the medical officer (or, as the case may be, the officer of the Department of Social Security) may specify, with such clinical information as the medical officer considers relevant about a patient to whom a medical certificate has been issued or whose request for the issue of such a certificate has been refused; and

(b) with information regarding any prescription form or medical certificate issued in respect of a patient or about any statement made in a report under this sub-paragraph.

    (2) For the purpose of being satisfied that the patient has consented as required by sub-paragraph (1), the performer may (unless the performer has reason to believe that the patient does not consent) rely on an assurance in writing from the medical officer, or any officer of the Department of Social Security, that that person holds the patient's written consent.

Patient records
     14.  - (1) Adequate records of the illnesses and treatment of patients shall be kept-

(a) on forms which shall be supplied to the provider for the purpose by the Health Board; or

(b) by way of computerised records where the provider has first obtained written consent of the Health Board.

    (2) Such a record shall be forwarded to the Health Board-

(a) on request of the Health Board, within 14 days;

(b) where the Board informs the provider of the death of a patient, within 14 days of the receipt of that information; and

(c) in any other case where a patient has died, not later than 30 days after the provider learns of that death.

Prescribing
     15. Where any drugs, medicines or listed appliances are needed for the treatment of any patient, paragraphs 29 to 31 of Schedule 1 to the GMS Regulations shall apply, except that for "treatment under these terms of service" or any related phrase there shall be substituted "treatment in connection with an agreement" or its related equivalent.

     16. Subject to paragraph 18(b) of this Schedule and paragraph 36(h) and (p) of Schedule 1 to the GMS Regulations (as applied by paragraph 18(b) of this Schedule) no fee or other remuneration shall be demanded or accepted from a patient for any prescription for any drug or appliance.

Provision of drugs or appliances for immediate treatment
     17. In addition to the performance of personal medical services, a performer-

(a) shall provide to a patient any appliance or drug, 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 appliance or drug, not being a Scheduled drug which the performer applies or provides to that patient.

Charges
     18. No fee or other remuneration shall be demanded or accepted for any treatment given to a patient, except -

(a) in those cases specified in sub-paragraphs (b), (e), (f), (h), (j) to (n) and (p) of paragraph 36 of Schedule 1 to the GMS Regulations;

(b) where a patient is treated under paragraph 9 of this Schedule, in which case a reasonable fee may be demanded and accepted for any treatment given, subject to any provisions in an agreement relating to the repayment of the fee to the patient;

(c) for treatment consisting of immunisation against a disease other than typhoid, paratyphoid, cholera, poliomyelitis and infectious hepatitis, which was requested in connection with travel abroad; or

(e) for treatment which is not a type usually provided by general medical practitioners and which is given-


(i) pursuant to section 57 of the 1978 Act; or

(ii) in a registered nursing home which is not providing services under the 1978 Act,



if, in either case, the performer providing the treatment is serving on the staff of a hospital providing services under the 1978 Act as a specialist providing treatment of the kind the patient requires, subject to any provisions in the agreement relating to the provision by the performer to the Health Board of information about the treatment.

(a) requires that the parties be bound by any determination made by the adjudicator to resolve the matter in dispute; and

(b) complies with the requirements specified in this Schedule.

     2. Any dispute arising out of or in connection with the agreement may be referred to an adjudicator appointed by the Scottish Ministers to consider and determine the matter in accordance with the provisions of this Schedule.

     3. Any party wishing to commence a dispute resolution under the provisions of this Schedule shall send to the Scottish Ministers a written request for dispute resolution which shall include or be accompanied by-

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

(b) a copy of the agreement;

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

     4.  - (1) Within the period of seven days beginning with the date of appointment to consider and determine a matter, the adjudicator shall-

(a) give to the parties notice in writing of the adjudicator's appointment; and

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

    (2) The adjudicator shall give, with the notice given under sub-paragraph (1), 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.

    (3) The adjudicator shall, upon receiving any representations from a party, give a copy of them to the other party and shall 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.

    (4) For the purposes of assisting in consideration of the matter, the adjudicator may-

(a) invite representatives of the parties to appear before the adjudicator 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 the adjudicator wishes them to give special consideration;

(b) consult other persons whose expertise the adjudicator considers will assist in consideration of the matter.

    (5) Where the adjudicator consults another person under sub-paragraph (4)(b), the adjudicator shall notify the parties accordingly and, where the adjudicator considers that the interests of any party might be substantially affected by the result of the consultation, the adjudicator shall give to the parties such opportunity as the adjudicator considers reasonable in the circumstances to make observations on those results.

    (6) In considering the matter, the adjudicator shall consider-

(a) any written representations made in response to a request under sub-paragraph (1)(b), but only if they are made within the specified period;

(b) any written observations made in response to a request under sub-paragraph (3), but only if they are made within the specified period;

(d) the results of a consultation under sub-paragraph (4)(b); and

(e) any observations made in accordance with an opportunity given under sub-paragraph (5).

    (7) In this Schedule, "specified period" means such period as the adjudicator shall specify in the request being not less than two, nor more than four, weeks beginning with the date on which the notice referred to is given but the adjudicator may, if the adjudicator considers that there is good reason for doing so, extend any such period (even after it has expired) and, where the adjudicator does so, a reference in this paragraph to the specified period is to the period as so extended.

     5. Subject to the other provisions of this Schedule and to any agreement by the parties, the adjudicator shall have discretion in determining the procedure of the dispute resolution to ensure the just, expeditious, economical and final determination of the dispute.

     6. The determination, and the reasons for it shall be recorded by the adjudicator in writing and notice of the determination (including the record of the reasons) shall be given to the parties and to the Scottish Ministers.