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General Medical Services Regulations (Northern Ireland) 1997

Type Ni-Statutory-Rule

Publication 1997-08-15

State In force

Jurisdiction Northern Ireland

Department Government Printer for Northern Ireland

Source legislation.gov.uk

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(15) A doctor who has received a notice sent in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Department against the determination and, pending the determination of the appeal, the Board shall not remove his name from the minor surgery list.

(16) An appeal to the Department under paragraph (15) shall be made in writing and shall include a statement of the grounds of appeal and on any such appeal the Department shall, if it allows the appeal, direct that the Board shall not remove the doctor’s name from the minor surgery list.

(17) The Board shall comply with any direction given to it under this regulation.

(18) Where the Department holds an oral hearing of an appeal pursuant to paragraph (11)(a), the appellant and the Board may be represented by counsel, solicitor or any other person.

Obtaining minor surgery services

36

(1) A person may apply, either in writing or in person, to a doctor—

(a) who is—

(i) the doctor in whose list he is included (in this paragraph referred to as “his own doctor”);

(ii) a doctor with whom his own doctor is in partnership; or

(iii) a doctor with whom his own doctor is associated in a group practice; and

(b) whose name is included in the medical list and the minor surgery list,

for the provision of a procedure specified in Schedule 7 and the provisions of regulation 19 shall apply to that application as if the reference in regulation 19 to an application to a doctor for inclusion in his list were a reference to an application to a doctor for minor surgery services.

(2) A doctor whose name is included in the medical list and the minor surgery list may, in respect of any person on his list or on the list of a doctor with whom he is in partnership or with whom he is associated in group practice, undertake to provide minor surgery services.

(3) A doctor who has undertaken, pursuant to paragraph (2), to provide minor surgery services in respect of any patient shall offer to provide any of the procedures described in Schedule 7 which it is, in his opinion, appropriate for him to provide in the case of that patient.

(4) Where a doctor provides minor surgery services in respect of a patient who is not included on his list, he shall inform in writing the doctor on whose list the patient is included of the outcome of the procedure.

(5) Nothing in this regulation shall prevent any doctor personally performing, in the course of providing general medical services (otherwise than by minor surgery services) to a patient, a procedure described in Schedule 7.

Part V — Payments to doctors

Payments

37

(1) The Board and the Agency shall make payments to doctors with whom arrangements for the provision of general medical services exist, in accordance with such rates and subject to such conditions as the Department may determine and publish in a Statement, after consultation with such organisations as may be recognised by the Department as representing doctors with whom arrangements for the provision of general medical services exist, and with the consent of the Department of Finance and Personnel, so as to secure compliance with section 8 of, and Schedule 2 to, the Finance Act (Northern Ireland) 1971[^f00026].

(2) The determination under paragraph (1) shall make provision for the following matters—

(a) basic practice allowance, and additional allowances for seniority and employment of assistants;

(b) standard capitation fees and capitation fees for elderly patients;

(d) fees and allowances for the supply of drugs and appliances and for rural practice;

(e) allowances for training doctors and for study leave;

(f) allowances for initial practice or to maintain practice viability;

(g) allowances to maintain practice viability for essential medical practices in isolated rural areas;

(h) allowances for practice expenses and, in particular, allowances for practice staff, including any who are spouses or other relatives;

(i) allowances for improvement of premises;

(j) such other payments or arrangements in respect of practice expenses or practice improvements as may be determined by the Department with the consent of the Department of Finance and Personnel;

(k) fees for contraceptive services;

(l) payments in relation to the making of arrangements for, and payments for, the temporary provision of general medical services;

(m) capitation fees in respect of patients who participate in a consultation pursuant to paragraph 16 of the terms of service;

(n) capitation fees in respect of patients to whom child health surveillance services are provided;

(o) capitation fees in respect of patients living in a deprived area;

(p) fees for minor surgery sessions undertaken;

(q) payments in respect of health promotion programmes approved by the Board;

(r) payments in respect of disease management programmes approved by the Board;

(s) target payments in respect of immunisations provided;

(t) target payments in respect of cervical cytology;

(u) allowances for the employment of locums by doctors during maternity leave, sickness or study leave;

(v) allowances for undergoing approved post-graduate education;

(w) allowances for the employment of doctors by isolated single-handed doctors;

(x) allowances in respect of providing placements in the practice for undergraduate medical students;

(y) transitional payments in consequence of changes to doctors' terms of service.

(3) The determination under paragraph (1) may be amended from time to time by the Department after consultation with the organisations referred to in that paragraph and with the consent of the Department of Finance and Personnel and any amendments shall also be published in a Statement.

(4) In this regulation “deprived area” means a ward of a local government district (within the meaning of section 1 of the Local Government Act (Northern Ireland) 1972[^f00027]) listed in the Statement referred to in paragraph (1).

Payments to suspended doctors

38

(1) The Board and the Agency shall make payments to any doctor who is suspended by direction of the Tribunal (“the suspended doctor”) in accordance with the Department’s determination in relation to such payments.

(2) The Department shall make the determination in accordance with paragraph (3) after consultation with the organisations referred to in regulation 37(1) and publish it with the Statement referred to in that regulation.

(3) The determination may be amended from time to time by the Department, after consultation with the organisations referred to in regulation 37(1) and any amendments shall also be published with the Statement referred to in that regulation.

(4) Subject to paragraphs (5) and (6), the Department’s determination shall be such as to secure that, as far as reasonably practicable, the suspended doctor receives all the payments which would have been due to him pursuant to regulation 37 had he provided such general medical services to his patients

during the period of his suspension as are actually provided by the doctor who becomes responsible for them during that period by virtue of regulation 24(2).

(5) To the extent that such payments consist of the reimbursement of expenses for which a doctor must submit a claim, the suspended doctor shall receive reimbursement only in respect of those expenses which he continues to incur during the period of his suspension.

(6) In a case to which paragraph 8B(3) of Part I of Schedule 11 to the Order[^f00028] applies, the determination shall provide for a deduction to take account of any payments which the suspended doctor receives for providing general medical services as an assistant or deputy.

Claims and overpayments

39

(1) Any claim for fees, allowances or other remuneration by a doctor shall be made in accordance with the provisions of the Statement under regulation 37.

(2) Where a Board or the Agency considers that a payment has been made to a doctor in circumstances when it was not due, it shall, except to the extent that the Department, on the Board’s or the Agency’s application, directs otherwise, draw the overpayment to his attention and—

(a) where the overpayment is admitted by him; or

(b) where the overpayment is not so admitted but the matter having been referred under regulation 5(1) of the Disciplinary Procedures Regulations for investigation, the Board or the Agency, or the Department on appeal under regulation 9(1)(c) of those Regulations, decides that there has been an overpayment,

the overpayment shall be recoverable either by deduction from the doctor’s remuneration or in some other manner.

(3) Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service.

Part VI — Miscellaneous

Determination of question of whether a substance is a drug, and recovery of cost

40

(1) Any question as to whether a substance supplied or ordered by a doctor for provision by a chemist is a drug, the provision of which formed part of pharmaceutical services provided under the Order, shall be determined under the provisions of this regulation.

(2) Where it appears to a Board, having been notified by the Agency, that a question arises under paragraph (1), the Board shall—

(a) notify in writing the doctor who supplied or ordered the substance of the nature of the question arising; and

(b) invite him to state in writing, within 30 days from the date on which the notice was sent to him, whether he wishes the question to be referred to the Local Medical Committee for its opinion.

(3) The Board—

(a) shall, where the doctor states that he wishes the question to be referred to the Local Medical Committee for its opinion, refer the question accordingly;

(b) in any other case, may refer the question to the Local Medical Committee for its opinion; and

(c) may, in any event, seek such medical or pharmaceutical advice as it thinks fit, otherwise than from the Local Medical Committee.

(4) Where the question is referred to the Local Medical Committee under the provisions of paragraph (3), that Committee shall—

(a) furnish the doctor concerned with a statement indicating the nature of the question referred to it by the Board; and

(b) give the doctor concerned a reasonable opportunity to—

(i) submit to the Local Medical Committee any statement in writing; and

(ii) appear before it and be heard by it, in connection with the question so referred.

(5) The Local Medical Committee shall—

(a) in forming its opinion under this regulation, have regard to any information or evidence provided by the Board or the Agency in connection with the question referred to it; and

(b) inform the doctor and the Board, in writing, of its opinion, its findings of fact and its reasons for its opinion.

(6) The Board shall—

(a) send notice of the question, in writing, to—

(i) the doctor who supplied or ordered the substance;

(ii) the person to whom the order was given; and

(iii) any other person who, in the opinion of the Board, has an interest in the determination of the question; and

(b) invite any such person to submit to the Board his comments, in writing, on that question within 30 days or within such further period as the Board may, for reasonable cause, allow.

(7) The Board shall, in determining the question, have regard to any opinion obtained by it under any of the provisions of paragraphs (3) to (5), and shall—

(a) send notice of its decision, in writing, to—

(i) the doctor concerned;

(ii) the Local Medical Committee; and

(iii) any person who submitted comments under paragraph (6); and

(b) where it determines that the substance in question is not a drug the provision of which forms part of pharmaceutical services, inform the doctor of his right of appeal under paragraph (8).

(8) Where the Board has determined that the substance in question is not a drug the provision of which forms part of pharmaceutical services, the doctor may appeal to the Department by giving notice of appeal within 30 days from the date on which the notice of the decision was sent to him or within such longer period as the Department may, for reasonable cause, allow.

(9) Any notice of appeal given under this regulation shall be given in writing and shall contain a concise statement of the grounds of appeal.

(10) The Department shall send a copy of the notice of appeal to the Board and to any person who submitted comments to the Board under paragraph (6).

(11) Any person to whom a copy of the notice of appeal is sent pursuant to paragraph (10), may, within 30 days from the date on which the notice was sent to him, make representations in writing to the Department on the appeal.

(12) The Department shall require an oral hearing of the appeal and shall nominate up to 3 persons to hear the appeal, of whom—

(a) at least one is a medical practitioner; and

(b) none are officers of the Department.

(13) An oral hearing shall take place at such time and place as the Department may direct, and notice of the hearing shall be sent, not less than 14 days before the date fixed for the hearing, to the doctor and to any person who received a copy of the notice of appeal under paragraph (10).

(14) The doctor and any person mentioned in paragraph (10) may attend and be heard in person or by counsel, solicitor or other representative and the Board may be represented at the hearing by any duly authorised officer or member, or by counsel or solicitor.

(15) The persons nominated by the Department under paragraph (12) shall determine the procedure at the oral hearing as they see fit and, on determining the appeal, shall either—

(a) allow the appeal; or

(b) confirm the decision of the Board,

and shall inform the Department of their findings of fact.

(16) The Department shall, as soon as practicable, send to the doctor and to any person mentioned in paragraph (10) notice in writing of its decision on the appeal and shall include in the notice a statement of its reasons for the decision and of its findings of fact.

(17) Where the Board or, on appeal, the Department has determined that a substance is not a drug the provision of which forms part of pharmaceutical services provided under the Order, the Board shall recover from the doctor who, or whose deputy or assistant, supplied or ordered the substance, by deduction from his remuneration or otherwise, an amount calculated in accordance with paragraph (19).

(18) Any amount determined as being recoverable under this regulation shall be a debt owing by the doctor to the Board.

(19) For the purposes of paragraph (18), the amount to be recovered in respect of the supply of any substance shall be the cost of that substance to the Board, including the dispensing fee payable in respect of the preparation in accordance with the Drug Tariff published under regulation 9 of the Pharmaceutical Regulations, and where the substance was an ingredient in a preparation of which other ingredients were drugs, the amount to be recovered shall be the cost of that substance to the Board together with one-half of the amount of the dispensing fee payable in respect of the supply of the preparation.

Publication of particulars

41

(1) Each Board shall publish the local directory and shall make available for inspection at its principal office copies of—

(a) the local directory;

(b) a compendium of practice leaflets provided to it by doctors whose names are included in the medical list;

(d) the Statement published under regulation 37,

and shall keep them up to date.

(2) The Agency shall publish the medical list and the obstetric list and shall make copies of them available for inspection at its office together with a copy of the Statement published under regulation 37 and shall keep them up to date.

(3) The Board and the Agency shall make the documents mentioned in paragraphs (1) and (2) available for inspection at such other places as appear to them convenient for informing all persons interested or may publish at such places a notice of the places and times at which copies of such documents may be seen.

(4) The Agency shall—

(a) send a copy of the medical list and the obstetric list to the Department, each Board, the Medical Committee, the Obstetric Committee, the Local Pharmaceutical Committee, each Local Medical Committee and the General Medical Services Committee of the British Medical Association; and

(b) at intervals of not more than 3 months notify each of the bodies mentioned in sub-paragraph (a) of any alterations in the lists mentioned in that sub-paragraph.

(5) Notwithstanding paragraph (4), if the Agency considers that only parts of the medical list or the obstetric list, or that only some of the alterations, are likely to concern the bodies mentioned in that paragraph, it may send to those bodies a copy of only those parts or alterations.

Appointment of medical adviser

42

A Board shall appoint a doctor to assist it in the exercise of its functions pursuant to paragraph 55 of the terms of service for doctors (inquiries about prescriptions and referrals).

Guidance to doctors

43

(1) A Board may issue guidance to doctors whose names are included in the medical list to assist them in assessing, in accordance with paragraph 35 of the terms of service, the qualifications, experience and competence of any employee or prospective employee.

(2) Any guidance issued for the purposes of paragraph (1) in connection with the employment of members of any profession or other occupational group shall have regard to any statement as to minimum professional standards of conduct published by any body responsible for the regulation of that profession or occupational group.

Revocations

44

(1) Regulation 3 of the Central Services Agency Committees (Amendment) Regulations (Northern Ireland) 1989[^f00029] is hereby revoked

(2) The Regulations specified in Schedule 15 are hereby revoked.

SCHEDULE 1 — Provisions Conferring Powers Exercised in Making these Regulations

Column 1	Column 2
Provision	Relevant amendments
The Health and Personal Social Services (Northern Ireland) Order 1972[^f00030]
Article 55(3)	None.
Article 56(1), (2), (3), (3A), (4), (4B) and (5)	The Health and Personal Social Services (Northern Ireland) Order 1978[^f00031] Article 12; The European Communities (Medical, Dental and Nursing Professions) (Linguistic Knowledge) Order 1981[^f00032], Article 5(1); The Health and Personal Social Services and Public Health (Northern Ireland) Order 1986[^f00033], Article 7; The Health and Medicines (Northern Ireland) Order 1988[^f00034], Article 4(5); The Health and Personal Social Services (Northern Ireland) Order 1991[^f00035], Article 29(1) and Schedule 6; and The Medical (Professional Performance) Act 1995[^f00036], section 4 and paragraph 30(a) and (b) of the Schedule.
Article 64(1)	The Health and Personal Social Services (Amendment) (Northern Ireland) Order 1986[^f00037], Article 5(2); and The Health and Personal Social Services (Northern Ireland) Order 1991, Article 31(2)
Article 95	None
Article 106(b)	None
Article 107(6)	None
Schedule 3, paragraph 7	None
The Health and Medicines (Northern Ireland) Order 1988
Article 4(1) and (4)	None
Article 10(1) and (2)	None

SCHEDULE 2 — Terms of Service for Doctors

Interpretation

1

In this Schedule—

“appliance” means an appliance which is included in a list for the time being approved by the Department for the purposes of Article 63 of the Order[^f00038];

“assistant” includes a trainee general practitioner;

“chemical reagent” means a chemical reagent which is included in a list for the time being approved by the Department for the purposes of Article 63 of the Order;

“deputy” means a person to whom a doctor has, under paragraph 20, delegated the treatment of his patients;

“drug” includes medicine;

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

“notice” means notice in writing;

“post-natal period” means the period of 14 days following the conclusion of a pregnancy;

“prescription form” means a form provided by the Agency and issued by a doctor to enable a person to obtain pharmaceutical services as defined by Article 63(1) of the Order;

“the Regulations” means the General Medical Services Regulations (Northern Ireland) 1997;

“Scheduled drug” means a drug or other substance specified in Schedule 10 or, except where the conditions in paragraph 45(2) are satisfied, in Schedule 11;

“single-handed practice” means a practice in which only one doctor is engaged.

General

2

Where a decision whether any, and if so what, action is to be taken under these terms of service requires the exercise of professional judgement, a doctor shall not, in reaching that decision, be expected to exercise a higher degree of skill, knowledge and care than—

(a) in the case of a doctor providing child health surveillance services under regulation 27, maternity medical services under regulation 34 or minor surgery services under regulation 36, that which any general practitioner whose name is included in the child health surveillance list, the obstetric 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 practitioners as a class may reasonably be expected to exercise.

A doctor’s patients

3

(1) Subject to sub-paragraph (2) and to paragraphs 9, 10, 11 and 12, a doctor’s patients are—

(a) persons who are recorded by the Agency as being on his list;

(b) persons whom he has accepted or agreed to accept for inclusion in his list, whether or not notification of that acceptance has been received by the Agency, and who have not been notified to him by the Agency as having ceased to be on his list;

(c) for the limited period specified in sub-paragraphs (4) and (5), persons whom he has refused to accept for inclusion in his list;

(d) persons who have been assigned to him under regulation 20;

(e) for the limited period specified in sub-paragraph (6), persons in respect of whom he has been notified that an application has been made for assignment to him in a case to which regulation 20(3)(b) applies;

(f) persons whom he has accepted for inclusion in his list as temporary residents;

(g) in respect of services under paragraph 8, persons to whom he has agreed to provide those services;

(h) persons to whom he may be requested to give treatment which is immediately required owing to an accident or other emergency at any place in his practice area, provided that—

(i) he is not, at the time of the request, relieved of liability to give treatment under paragraph 4; and

(ii) he is not, at the time of the request, relieved under paragraph 23(2) of his obligation to give treatment personally; and

(iii) he is available to provide such treatment,

and any persons by whom he is requested, and agrees, to give treatment which is immediately required owing to an accident or other emergency at any place in his practice area, provided there is no doctor who, at the time of the request, is under an obligation otherwise than under this head to give treatment to that person, or there is such a doctor but, after being requested to attend, he is unable to attend and give treatment immediately required;

(i) persons in relation to whom he is acting as deputy for another doctor under these terms of service;

(j) during the period of an appointment under regulation 24, persons whom he has been appointed to treat temporarily;

(k) in respect of child health surveillance services, contraceptive services, maternity medical services or minor surgery services, persons for whom he has undertaken to provide such services; and

(l) any person for whom he has accepted responsibility under an arrangement made under paragraph 20(2).

(2) Except in a case to which head (h), (i) or (j) of sub-paragraph (1) applies, a person shall not be a patient for the purposes of that sub-paragraph if a doctor has been notified by the Agency that he is no longer responsible for the treatment of that person.

(3) Where a person applies to a doctor for treatment and claims to be on that doctor’s list, but fails to produce his medical card on request and the doctor has reasonable doubts about that person’s claim, the doctor shall give any necessary treatment and shall be entitled to demand and accept a fee accordingly under paragraph 43(e), subject to the provision for repayment contained in paragraph 44. A doctor shall not order any drug or appliance on one of the order forms provided by the Agency so as to enable the person to obtain a drug or appliance as part of pharmaceutical services.

(4) Where a doctor—

(a) refuses to accept for inclusion in his list a person who lives in his practice area and who is not included in the list of another doctor practising in that area; or

(b) refuses to accept for inclusion in his list as a temporary resident a person to whom regulation 25 applies;

he shall on request give that person any immediately necessary treatment 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 he requested the immediate removal of that person from his list), or until that person has been accepted by or assigned to another doctor, whichever occurs first.

(5) Where a doctor on the obstetric list refuses to provide maternity medical services in the case of a woman who applies to him for such services in accordance with regulation 34(2) or (3) and who is residing in the area within which the doctor has undertaken to provide maternity medical services, he shall, unless he is satisfied that she is already receiving maternity medical services from any other doctor in the area—

(a) give without charge to her such treatment including the supply of drugs and appliances, as may be immediately necessary, pending her acceptance for inclusion in the list of another doctor; and

(b) inform her of the name and place of attendance of any neighbouring doctor whose name is included in the obstetric list to whom application might be made and of the address of the nearest ante-natal clinic.

(6) Where the Agency has notified a doctor that it is applying for the Department’s consent under regulation 20(3)(b), the doctor shall give the person proposed for assignment any immediately necessary treatment until the Agency has notified him that—

(a) the Department has determined whether or not the person is to be assigned to that doctor; and

(b) either the person has been accepted by, or assigned to, another doctor or another doctor has been notified that an application has been made, in a case to which regulation 20(3)(b) applies, to assign that person to him.

(7) Nothing in this paragraph shall require a doctor to be responsible for the treatment in hospital of a person admitted to that hospital unless—

(a) he is a member of staff of the hospital and the terms of his appointment allow him to provide—

(i) general medical services (other than maternity medical services); or

(ii) in the case of a doctor whose name is included in the obstetric list, maternity medical services; or

(b) the hospital concerned, or part of that hospital, is one in which patients are entitled to secure treatment by their own doctor, whether or not such doctor is a member of staff of that hospital.

4

A doctor who is elderly or infirm or who has been exempted by the Agency under regulation 20(5) from the liability to have persons assigned to him may be relieved by the Board of any liability to give treatment which is immediately required owing to an accident or other emergency between 7 pm on weekdays and 8 am on the following morning and between 1 pm on Saturday and 8 am on the following Monday to persons who are neither—

(a) on his list; nor

(b) temporary residents for whom he is responsible; nor

Acceptance of patients

5

(1) Subject to sub-paragraph (2), a doctor may agree to accept a person for inclusion in his list if the person is eligible to be so accepted by him.

(2) Where a doctor is responsible for treating the patients of another doctor whose name has been removed from the medical list, he may not consent to the transfer of any of those patients under regulation 21 to his own list or to that of his partner.

(3) Where a doctor has agreed to accept a person for inclusion in his list he shall, within 14 days of receiving that person’s medical card or 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, the form of application; and

(b) send it to the Agency.

(4) Where, for the purposes of sub-paragraph (3), any person signs a medical card or form of application on behalf of a doctor he shall, in addition to his own signature, specify the name of the doctor on whose behalf he is signing.

6

A doctor may—

(a) undertake to provide contraceptive services to a woman who has applied to him in accordance with regulation 28;

(b) accept for inclusion in his list as a temporary resident a person who has applied to him in accordance with regulation 25(1);

(c) if his name is on the obstetric list, undertake to provide maternity medical services to a woman who has made an arrangement with him in accordance with regulation 34(2) or (3).

7

Notwithstanding that the person concerned is not on his list, a doctor may—

(a) take a cervical smear from a woman who would be eligible for acceptance by him for inclusion in his list as a temporary resident or for whom he has undertaken to provide maternity medical services or contraceptive services; and

(b) vaccinate or immunise a person who would be eligible for acceptance by him for inclusion in his list as a temporary resident.

8

Where a doctor whose name is included in the obstetric list undertakes to provide maternity medical services required by a woman who applies to him in accordance with regulation 34(2) or (3), he shall advise the Board of the arrangement in such a form as it may require.

Termination of responsibility for patients

9

(1) Subject to paragraph 10, a doctor may have any person removed from his list and shall notify the Agency in writing that he wishes to have a person removed from his list and, subject to sub-paragraph (2), the removal shall take effect—

(a) on the date on which the person is accepted by or assigned to another doctor; or

(b) on the eighth day after the Agency receives the notice,

whichever is the sooner.

(2) Where, at the date when the removal would take effect under sub-paragraph (1), the doctor is treating the person at intervals of less than 7 days, the doctor shall inform the Agency in writing of the fact and the removal shall take effect—

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

(b) on the date on which the person is accepted by or assigned to another doctor,

whichever is the sooner.

10

(1) Where—

(a) a person on a doctor’s list has committed an act of violence against that doctor or has behaved in such a way that that doctor has feared for his safety; and

(b) that doctor has reported the incident to the police,

that doctor may notify the Agency that he wishes to have that person removed from his list with immediate effect.

(2) 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 7 days (and, for the purpose of this paragraph, a notification given by fax is not a notification given in writing).

(3) The time at which the doctor notifies the Agency shall be the time at which he makes the telephone call or sends or delivers the notification to the Agency.

(4) Where, pursuant to this paragraph, a doctor has notified the Agency that he wishes to have a person’s name removed from his list with immediate effect, he shall take all reasonable steps to inform the person concerned.

11

Where a doctor informs the Agency, in writing, that he wishes to terminate his responsibility for a temporary resident, his responsibility for that person shall cease in accordance with paragraph 9, as if the temporary resident were a person on his list.

12

(1) A doctor with whom an arrangement has been made for the provision of any or all of the maternity medical services mentioned in regulation 34(1)(a) may agree with the woman concerned to terminate the arrangement and, in default of agreement, the doctor may apply to the Board for permission to terminate the arrangement.

(2) On an application under sub-paragraph (1), the Board, after considering any representations made by either party and after consulting the Local Medical Committee, may terminate the arrangement.

(3) Where a doctor ceases to provide any or all of the maternity medical services mentioned in regulation 34(1)(a), he shall inform any woman for whom he has arranged to provide such services that he is ceasing to provide them and that she may make a fresh arrangement to receive those services from another doctor.

Services to patients

13

(1) Subject to paragraphs 2, 16 and 49, a doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general practitioners.

(2) The services which a doctor is required by sub-paragraph (1) to render shall include 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 consultation and, where appropriate, physical examination for the purpose of identifying, or reducing the risk of, disease or injury;

(c) offering to patients, where appropriate, vaccination or immunisation against measles, mumps, rubella, pertussis, poliomyelitis, diphtheria, tetanus and haemophilus influenzae type b;

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

(e) giving advice, as appropriate, to enable patients to avail themselves of personal social services provided under the Order.

(3) A doctor is not required by sub-paragraph (1) or (2)—

(a) to provide to any person child health surveillance services, contraceptive services, minor surgery services nor, except in an emergency, maternity medical services unless he has previously undertaken to the Board to provide such services to that person; or

(b) where he is a restricted services principal, to provide any category of general medical services which he has not undertaken to provide.

(4) If a woman requires treatment immediately owing to an obstetric emergency, it shall be the duty of any doctor whose name is included in the obstetric list in whose practice area the emergency arises, who is summoned and is available or at whose surgery the woman attends and such a doctor is available, to give any treatment immediately necessary, unless a doctor who has undertaken to provide maternity medical services for her or his partner, deputy or assistant is available, and treatment under this sub-paragraph shall be given without charge unless she is not entitled to receive maternity medical services.

(5) Any charge made by a doctor in respect of treatment provided under sub-paragraph (4) shall be in accordance with any determination which may be made by the Department under regulation 37(2)(c).

(6) The treatment referred to in sub-paragraph (4) shall be given whether or not the woman is able to produce evidence of her entitlement to maternity medical services.

Provision of services to patients during and outside normal hours

14

(1) In this paragraph, the services referred to in paragraph 13 are called the “relevant services”.

(2) Subject to the following provisions of this paragraph, a doctor shall render the relevant services during the hours for which he is normally available pursuant to paragraph 36 (in this paragraph referred to as “normal hours”)—

(a) at his practice premises; or

(b) in the case of a patient whose condition is such that, in the doctor’s reasonable opinion, it would be inappropriate for the patient to attend at the practice premises, at whichever of the places set out in sub-paragraph (5) as is appropriate.

(3) Outside normal hours, the doctor shall consider, in the light of the patient’s medical condition, whether a consultation is needed and, if so, when.

(4) If, in the doctor’s reasonable opinion, a consultation is needed before the next time at which the patient could be seen during normal hours, he shall render the relevant services—

(a) at his practice premises;

(b) at such other place as the Board has agreed, pursuant to paragraph 37, and he has informed the patient, pursuant to that paragraph, is a place where he will treat patients outside normal hours; or

(c) in the case of a patient whose condition is such that, in the doctor’s reasonable opinion, it would be inappropriate for the patient to attend either at the practice premises or at such other place, at whichever of the places set out in sub-paragraph (5) as is appropriate.

(5) The places referred to in sub-paragraphs (2)(b) and (4)(c) are—

(a) the place where the patient was residing when he was accepted by the doctor for inclusion in his list pursuant to paragraph 5 or, as the case may be, when he was assigned to the doctor pursuant to regulation 20 or, in the case of a patient who was previously on the list of a doctor in a practice declared vacant, when the doctor succeeded to the vacancy;

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

(6) Nothing in this paragraph prevents the doctor from—

(a) arranging for the referral of a patient pursuant to paragraph 13(2)(d) 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 this paragraph does not place him under an obligation to do so.

15

(1) Subject to sub-paragraph (2), unless prevented by an emergency, a doctor shall attend and treat any patient who attends for the purpose at any place, and during the hours, for the time being approved by the Board under paragraph 36.

(2) Sub-paragraph (1) shall not apply to a patient who attends when an appointment system is in operation and who has not previously made, and is not then given, an appointment to see the doctor.

(3) A doctor may refuse to attend and treat the patient to whom sub-paragraph (2) applies, provided that—

(a) the patient’s health would not thereby be jeopardised; and

(b) the patient is offered an appointment to attend again within a time which is reasonable having regard to all the circumstances.

(4) A doctor shall take reasonable steps to ensure that no refusal is made pursuant to sub-paragraph (3) without his knowledge.

Newly registered patients

16

(1) Subject to sub-paragraphs (4) to (10), where a patient has been accepted for inclusion in a doctor’s list under paragraph 5 or assigned to a doctor’s list under regulation 20, the doctor shall, in addition to and without prejudice to his other obligations in respect of that patient under these terms of service, within 28 days of the date of such acceptance or assignment, invite the patient to participate in a consultation either at his practice premises or, if the condition of the patient so warrants, at such other place as the doctor is obliged under paragraph 14(2)(b) to render personal medical services to that patient.

(2) Where a patient (or, in the case of a patient who is a child, his parent) agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i) illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer;

(ii) social factors (including employment, housing and family circumstances) which may affect his health;

(iii) factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol and misuse of drugs or solvents) which may affect his health; and

(iv) the current state of his health;

(b) offer to undertake a physical examination of the patient, comprising—

(i) the measurement of his blood pressure;

(ii) the taking of a urine sample and its analysis to identify the presence of albumen and glucose; and

(iii) the measurements necessary to calculate his body mass;

(c) record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d) assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient;

(e) in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient (or, where the patient is a child, his parent) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(3) On each occasion on which a doctor invites a patient to participate in a consultation mentioned in sub-paragraph (1) he shall—

(a) make the invitation in writing or, if the invitation is initially made orally, confirm it in writing by a letter either handed to the patient or his representative or sent to the patient (or, in the case of a patient who is a child, his parent) at the address recorded in his medical records as being his last known home address;

(b) record in the patient’s medical records the date of each such invitation and whether or not it was accepted; and

(c) where, as a result of making the invitation, the doctor becomes aware that the patient is no longer residing at the address shown in those medical records, advise the Agency accordingly.

(4) A doctor shall not be obliged to offer a consultation mentioned in sub-paragraph (1)—

(a) if he is a restricted services principal;

(b) in respect of a child under the age of 5 years; or

(c) to any patient who, immediately before his inclusion in his list, was a patient of a partner of the doctor and who, during the 12 months immediately preceding the date of his acceptance for inclusion in, or assignment to, the doctor’s list, had participated in a consultation mentioned in sub-paragraph (1); or

(d) to the extent allowed by the Board, to any patient within a class of patients in respect of which the Board or, on appeal, the Department has, pursuant to sub-paragraphs (5) to (9), deferred the doctor’s obligation under sub-paragraph (1).

(5) Where a doctor assumes responsibility for a list of patients on his succession to a practice declared vacant or otherwise becomes responsible for a significant number of new patients within a short period, he may apply, in accordance with sub-paragraph (6), to the Board for the deferment of his obligation under sub-paragraph (1) for a period not exceeding 2 years from the date of the application.

(6) An application pursuant to sub-paragraph (5) shall be made in writing and shall be accompanied by a statement of the doctor’s proposals, by reference to particular classes of patient, with a view to securing that all eligible patients are invited to participate in a consultation mentioned in sub-paragraph (1) by the end of the period of the deferment.

(7) Within 2 months of receiving an application pursuant to sub-paragraph (5), the Board shall determine it—

(a) by approving the application;

(b) by approving the application subject to conditions; or

(8) The Board shall give notice to the doctor of its determination under sub-paragraph (7) and—

(a) where it imposes conditions pursuant to head (b) of that sub-paragraph; or

(b) refuses the application pursuant to head (c) of that sub-paragraph,

it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (9).

(9) A doctor may, within the period of 30 days beginning with and including the day on which he receives notice of the Board’s determination, appeal in writing to the Department against any refusal of an application, or against any condition subject to which an application is approved by the Board pursuant to sub-paragraph (7)(b) and, on determining such an appeal, the Department shall either confirm the Board’s determination or substitute its own determination for that of the Board.

(10) The Department shall notify the doctor in writing of its determination and shall include with the notice a statement of its reasons for the determination.

(11) In this paragraph and paragraph 17, “body mass” means the figure produced by dividing the number of kilograms in the patient’s weight by the square of the number of metres in his height.

Patients not seen within 3 years

17

(1) Subject to sub-paragraph (2), where a patient who—

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

(b) within the preceding 3 years has attended neither a consultation with, nor a clinic provided by, any doctor in the course of his provision of general medical services,

requests a consultation for the purposes of assessing whether he needs personal medical services, a doctor shall, in addition to and without prejudice to any other obligation under these terms of service, provide such a consultation.

(2) Sub-paragraph (1) shall not apply in the case of a doctor who is a restricted services principal.

(3) Where a doctor provides a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i) illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer;

(ii) social factors (including employment, housing and family circumstances) which may affect his health;

(iii) factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol and misuse of drugs or solvents) which may affect his health; and

(iv) the current state of his health;

(b) offer to undertake a physical examination of the patient, comprising—

(i) the measurement of his blood pressure;

(ii) the taking of a urine sample and its analysis to identify the presence of albumen and glucose; and

(iii) the measurements necessary to detect any changes in body mass;

(c) record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d) assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient;

(e) in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

Patients aged 75 years and over

18

(1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligations under these terms of service, in each period of 12 months beginning on 1st April in each year—

(a) invite each person on his list who has attained the age of 75 years to participate in a consultation; and

(b) offer to make a domiciliary visit to each such patient,

for the purpose of assessing whether he needs to render personal medical services to that patient.

(2) Sub-paragraph (1) shall not apply in the case of any doctor who is a restricted services principal.

(3) Any consultation pursuant to sub-paragraph (1) may take place in the course of a domiciliary visit pursuant to that sub-paragraph.

(4) In the case of a patient who is accepted for inclusion in a doctor’s list pursuant to paragraph 5, or assigned to him pursuant to regulation 20, and who has attained the age of 75 years when he is so accepted or assigned, an invitation and an offer pursuant to sub-paragraph (1) shall be made within 12 months of the date of his acceptance or assignment.

(5) A doctor shall, when making an assessment following a consultation under sub-paragraph (1), record in the patient’s medical records the observations made of any matter which appear to him to be affecting the patient’s general health including, where appropriate, the patient's—

(a) sensory functions;

(b) mobility;

(d) physical condition including continence;

(e) social environment; and

(f) use of medicines.

(6) A doctor shall keep with the patient’s medical records a report of any observations made in the course of a domiciliary visit made pursuant to sub-paragraph (1) which are relevant to the patient’s general health.

(7) When inviting a patient to participate in a consultation or offering him a domiciliary visit pursuant to sub-paragraph (1), a doctor shall comply with the requirements of paragraph 16(3) as if that paragraph referred to such an offer as well as to an invitation.

(8) Where a patient has participated in a consultation pursuant to sub-paragraph (1), the doctor shall offer to discuss with him the conclusions he has drawn, as a result of the consultation, as to the state of the patient’s health, unless to do so would, in the opinion of the doctor, be likely to cause serious harm to the physical or mental health of the patient.

Transfer of responsibility, absences, deputies, assistants and partners

19

Subject to paragraph 20 a doctor is responsible for ensuring the provision for his patients of the services referred to in paragraph 13 throughout each day during which his name is included in the medical list.

20

(1) In this paragraph and in paragraph 21—

(a) “out of hours period” means—

(i) the period beginning at 7 pm on a weekday other than a Saturday and ending at 8 am on the following day;

(ii) the period between 1 pm on a Saturday and 8 am on the following Monday; and

(iii) Bank and Public holidays,

and “part of an out of hours period” means any part of any one or more of the periods described in sub-heads (i) to (iii);

(b) “out of hours arrangement” means an arrangement under sub-paragraph (2); and

(c) “transferee doctor” means a doctor who has undertaken to carry out the obligations of another doctor under these terms of service during part or all of the out of hours period in accordance with an out of hours arrangement.

(2) Subject to sub-paragraphs (3) to (15), a doctor may, with the approval of the Board, make an arrangement with a doctor whose name is included in the medical list to transfer his obligations under the terms of service during part or all of the out of hours period to that other doctor.

(3) A doctor may make more than one out of hours arrangement; and may do so (for example) with different transferee doctors and in respect of different patients, different times and different parts of his practice area.

(4) A doctor may retain responsibility for or make separate out of hours arrangements in respect of the provision of maternity medical services to patients with whom he has made an arrangement under regulation 34.

(5) Nothing in this paragraph shall prevent a doctor from retaining or resuming his obligations in relation to named patients.

(6) Where a doctor’s name is included in the obstetric list, he shall not make an out of hours arrangement in respect of the provision of maternity medical services to patients with whom he has made an arrangement under regulation 34 unless the transferee doctor’s name is also included in the obstetric list.

(7) An application to the Board for approval shall be made in writing and shall state—

(a) the name and address of the proposed transferee doctor, and the number of patients on his list;

(b) the periods during which the doctor’s obligations under these terms of service are to be transferred;

(c) how the proposed transferee doctor intends to meet the doctor’s obligations during the periods specified under head (b);

(d) the arrangements for the transfer of the doctor’s obligations under these terms of service to and from the transferee doctor at the beginning and end of the periods specified under head (b);

(e) whether the proposed arrangement includes the doctor’s obligations in respect of maternity medical services;

(f) how long the proposed arrangements are intended to last and the circumstances in which the doctor’s obligations under these terms of service during the periods specified under head (b) would revert to him;

(g) what arrangements are proposed to enable the doctor’s patients to contact the proposed transferee doctor; and

(h) whether the proposed transferee doctor—

(i) has been notified under regulation 7(4) of the Tribunal Regulations (Northern Ireland) 1995[^f00039] that the Tribunal intends to hold an inquiry under paragraph 1 of Schedule 11 to the Order as to representations made in relation to him; or

(ii) has been notified under section 42(5) of the Medical Act 1983[^f00040] that the Preliminary Proceedings Committee of the General Medical Council has decided that he should be referred to the Professional Conduct Committee or to the Health Committee.

(8) A 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.

(9) A Board shall grant approval to a proposed out of hours arrangement if it is satisfied—

(a) having regard in particular to the interests of the doctor’s patients, that the arrangement is reasonable;

(b) having regard in particular to all reasonably foreseeable circumstances, that the arrangement is practicable and will work satisfactorily;

(c) that it will be clear to the doctor’s patients how to seek personal medical services during the out of hours period; and

(d) that if the arrangement comes to an end, the doctor has in place proper arrangements for the immediate resumption of his responsibilities,

and shall not refuse to grant approval without first consulting the Local Medical Committee.

(10) The Board shall give notice to the doctor of its determination and, where it refuses an application, it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (11).

(11) A doctor may, within the period of 30 days beginning with and including the day on which the Board’s notification under sub-paragraph (10) was received by him, appeal in writing to the Department against any refusal of an application made under sub-paragraph (7).

(12) The Department may, when determining an appeal, either confirm the determination of the Board or substitute its own determination for that of the Board.

(13) The Department shall give notice to the doctor of its determination and shall in every case include with the notification a written statement of the reasons for the determination.

(14) Where the Board (or, on appeal, the Department) has approved an out of hours arrangement—

(a) the transferee doctor may himself employ or engage an assistant or deputy in respect of part or all of the period covered by the out of hours arrangement; and if he does so, paragraph 23 shall apply as if he were the doctor for the purposes of that paragraph; and

(b) a transferee doctor shall not enter into any other out of hours arrangement in respect of the patients for whom he has accepted responsibility under this paragraph.

21

(1) Subject to paragraph 22, where it appears to the Board that it may no longer be satisfied as to any of the matters referred to in heads (a) to (d) of paragraph 20(9), it may give notice in writing to the doctor that it proposes to review the approval.

(2) On any review under sub-paragraph (1), the Board shall allow the doctor 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 either to continue or to withdraw its approval but shall not withdraw its approval without first consulting the Local Medical Committee.

(4) The Board shall give notice to the doctor of a determination under sub-paragraph (3).

(5) Where the Board withdraws its approval, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (6).

(6) A doctor may, within the period of 30 days beginning with and including the day on which the notice referred to in sub-paragraph (4) was received by him, appeal in writing to the Department against the withdrawal of approval and sub-paragraphs (12) and (13) of paragraph 20 shall apply to any such appeal.

(7) Subject to paragraph 22(1), where the Board withdraws approval, the withdrawal shall not take effect until the end of the period of 2 months beginning with and including the date on which the notice referred to in sub-paragraph (4) was sent or where there is an appeal under sub-paragraph (6) and the appeal is dismissed, the date on which the doctor receives notice of the dismissal of the appeal, whichever is the later.

22

(1) Where it appears to the Board, whether after a review under paragraph 21 or not, that it is necessary in the interests of the doctor’s patients to withdraw its approval immediately, it may withdraw its approval.

(2) The Board shall give notice to the doctor of a determination under sub-paragraph (1) and shall include with the notice a statement of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (4).

(3) An immediate withdrawal of approval under paragraph (1) shall take effect on the day on which the notice referred to in sub-paragraph (2) is received by the doctor.

(4) A doctor may, within the period of 30 days beginning with and including the day on which the notice referred to in sub-paragraph (2) was received by him, appeal in writing to the Department against the withdrawal of approval and sub-paragraphs (12) and (13) of paragraph 20 shall apply to any such appeal.

23

(1) Subject to sub-paragraphs (2) to (7), a doctor shall give treatment personally.

(2) Subject to sub-paragraphs (3), (5) and (6), and to any out of hours arrangements made under paragraph 20(2), a doctor (in this sub-paragraph referred to as “the patient’s doctor”) shall be under no obligation to give treatment personally to a patient provided that reasonable steps are taken to ensure the continuity of the patient’s treatment, and in those circumstances the treatment may be given—

(a) by another doctor acting as a deputy, whether or not he is a partner or assistant of the patient’s doctor; or

(b) in the case of treatment which it is clinically reasonable in the circumstances to delegate someone other than a doctor, by a person whom the doctor has authorised and who he is satisfied is competent to carry out such treatment.

(3) Subject to sub-paragraph (4), in the case of maternity medical services a doctor whose name is included in the obstetric list shall not arrange for the provision of such services by another doctor unless that doctor’s name is included in the obstetric list.

(4) Sub-paragraph (3) shall not apply where there has been a summons to an obstetric emergency.

(5) In the case of child health surveillance services, a doctor who has, pursuant to regulation 27, undertaken to provide such services shall not arrange for the provision of such services by—

(a) another doctor unless that doctor’s name is included in the child health surveillance list; or

(b) any other person without the consent of the Board.

(6) In the case of minor surgery services, a doctor who has, pursuant to regulation 36, undertaken to provide such services shall not arrange for the provision of such services by—

(a) another doctor unless that doctor’s name is included in the minor surgery list; or

(b) any other person.

(7) In this paragraph “a summons to an obstetric emergency” means a summons to the doctor by a midwife or by or on behalf of the patient to attend when medical attention is required urgently by a woman or her baby during pregnancy, labour or the post-natal period.

24

(1) In relation to his obligations under these terms of service, a doctor is responsible for all acts and omissions of—

(a) any doctor acting as his deputy;

(b) any organisation providing deputy doctors as mentioned in paragraph 26 with which he has entered into an arrangement in accordance with that paragraph while acting on his behalf; and

except where the act or omission is one for which a deputy is responsible under sub-paragraph (2) or (3).

(2) Where a doctor whose name is included in the medical list is acting as a deputy to another doctor whose name is also included in that list, the deputy alone is responsible for—

(a) his own acts and omissions in relation to the obligations under these terms of service of the doctor for whom he acts as deputy; and

(b) the acts and omissions of any person employed by him or acting on his behalf.

(3) A deputy, including a partner acting as a deputy, or an assistant whose name is included in the obstetric list shall be responsible for his own acts and omissions.

25

(1) A doctor shall inform the Board of the arrangements for the engagement of a deputy on a regular basis unless the deputy—

(a) is an assistant of the doctor, or is a doctor whose name is included in the medical list; and

(b) is to carry out the arrangements at the doctor’s premises.

(2) Where the doctor proposes to be absent from his practice for more than 14 days, he shall inform the Board of the name of any doctor responsible for his practice during his absence.

26

(1) In this paragraph, “organisation providing deputy doctors” means a person who provides deputies to doctors and includes a body which—

(a) consists only of doctors whose names are included in the medical list and who arrange to act as deputies to each other; and

(b) keeps separate accounts in relation to such arrangements.

(2) Before entering into arrangements with an organisation providing deputy doctors for the provision of any deputy, a doctor shall—

(a) obtain the written agreement of that organisation that any doctor it provides to him—

(i) will not be subject to a declaration under either paragraph 3(c) of Schedule 11 to the Order or under any corresponding provision in force in England and Wales or Scotland that he is not fit to be engaged in any capacity in the provision of general medical services;

(ii) will not be suspended by direction of the Tribunal, other than in a case falling within paragraph 8B(3) of Schedule 11 to the Order;

(iii) will (unless he is a trainee general practitioner acting in the place of and under the supervision of the doctor responsible for his training) be suitably experienced within the meaning of Article 8 of the Health and Personal Social Services (Northern Ireland) Order 1978 (other than by virtue of being a restricted services principal) or will have the acquired right specified in regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994[^f00041]; and

(b) take all reasonable steps to satisfy himself that the service provided by the organisation (including its monitoring arrangements) will be adequate and appropriate having regard in particular to the interests of the doctor’s patients.

(3) A doctor shall notify the Board of any arrangements he makes with an organisation providing deputy doctors.

(4) A doctor shall from time to time and at any time when there are grounds for doing so, take reasonable steps to satisfy himself that an organisation providing deputy doctors with which he has entered into arrangements for the provision of any deputy—

(a) continues to comply with the agreement referred to in sub-paragraph (2)(a); and

(b) continues to provide a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b).

(5) Subject to sub-paragraph (6), if the Board so requests, a doctor shall furnish it with evidence that such an organisation is continuing—

(a) to comply with the agreement mentioned in sub-paragraph (2)(a); or, as the case may be,

(b) to provide a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b).

(6) A Board shall not make a request for evidence under sub-paragraph (5)(b) unless—

(a) it has reasonable grounds for believing that the organisation providing deputy doctors is not providing a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b); and

(b) it has consulted the Local Medical Committee.

(7) Subject to sub-paragraph (8), where in response to a request for evidence under sub-paragraph (5)(b) the Board continues to have reasonable grounds for believing that the organisation providing deputy doctors is not providing a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b), it shall give notice (in this paragraph referred to as a “remedial notice”) to the doctor specifying—

(a) the grounds for its concern;

(b) the remedial action which it considers necessary; and

(8) A Board shall not issue a remedial notice under sub-paragraph (7) without first consulting the Local Medical Committee.

(9) Where a Board issues a remedial notice under sub-paragraph (7), it shall also send a copy of that notice to any other doctor who has made arrangements with the organisation providing deputy doctors.

(10) Where it appears to the Board—

(a) that an organisation providing deputy doctors with which a doctor has made arrangements for the provision of a deputy—

(i) is not complying with the agreement referred to in sub-paragraph (2)(a); or

(ii) has not taken the action specified in a remedial notice issued under sub-paragraph (7) within the time specified in that notice; or

(b) that a doctor’s arrangement with such an organisation is such that the doctor’s patients are at risk,

it may give notice to the doctor requiring him to bring his arrangement with that organisation to an end either immediately or before such date as is stated in the notice.

27

A doctor shall not engage another doctor as a deputy, or employ one as an assistant, unless the other doctor—

(a) is suitably experienced within the meaning of Article 8 of the Health and Personal Social Services (Northern Ireland) Order 1978 (other than by virtue of being a restricted services principal); or

(b) has the acquired right specified in regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994; or

(c) is a trainee general practitioner acting in the place of and under the supervision of the doctor responsible for his training.

28

A doctor shall not engage as a deputy or employ as an assistant any doctor—

(a) who, having been disqualified under paragraph 3(b) of Schedule 11 to the Order (or under any corresponding provision in operation in England and Wales or Scotland) from inclusion of his name in the medical list (or, in England and Wales, the medical list of a Health Authority or, in Scotland, the medical list of a Health Board), is also the subject of a declaration under paragraph 3(c) of Schedule 11 to the Order (or any corresponding provision in operation in England and Wales or Scotland) that he is not fit to be engaged in any capacity in the provision of general medical services; or

(b) who is suspended by direction of the Tribunal, other than in a case falling within paragraph 8B(3) of Schedule 11 to the Order.

29

(1) A doctor shall—

(a) inform the Board of the name of any assistant he employs and of the termination of such employment;

(b) on request, furnish on a form supplied by the Board any information in connection with the employment notified to the Board in head (a) which may be required by the Agency for the purposes of the Health and Personal Social Services (Superannuation) Regulations (Northern Ireland) 1995[^f00042];

(c) not employ any one or more assistants for a total period of more than 3 months in any period of 12 months without the consent of the Board.

(2) The Board shall periodically review and may withdraw any consent given but, before refusing or withdrawing consent, the Board shall consult the Local Medical Committee and shall notify the doctor of any refusal or withdrawal of consent.

(3) The doctor may, within the period of 30 days beginning with and including the day on which he receives notification of the Board’s determination, appeal to the Department against any refusal or withdrawal of consent.

(4) Any withdrawal of consent under this paragraph shall not have any effect until the expiration of a period of one month after the date of notification of the withdrawal, but if the doctor appeals to the Department against the withdrawal and the Department dismisses the appeal, the withdrawal shall not take effect until after such date as the Department determines being a date falling not less than one month after the date of the dismissal of the appeal.

30

(1) A doctor acting as a deputy shall be entitled to treat patients at places and at times other than those arranged by the doctor for whom he is acting, due regard being had to the convenience of the patients.

(2) A doctor acting as a deputy for another doctor may not treat the other doctor’s patients at any place approved under paragraph 36 unless it is so approved for the availability of that other doctor.

31

When issuing any document under these terms of service, a deputy or assistant (other than a partner or assistant whose name is included in the medical list) shall, as well as signing the document himself, enter on it the name of the doctor for whom he is acting, if it does not already appear.

Practice Premises

32

A doctor shall not, except with the approval of the Board, provide general medical services in premises occupied by a chemist.

Arrangements at practice premises

33

A doctor shall—

(a) provide proper and sufficient accommodation—

(i) at his practice premises, having regard to the circumstances of his practice; and

(ii) at any other premises at which the Board, in accordance with paragraph 36, has agreed he may treat his patients; and

(b) on receipt of a written request from the Board, allow inspection of those premises at a reasonable time by a member or officer of the Board or Local Medical Committee or both, authorised by the Board for the purpose.

34

A doctor who—

(a) intends to operate an appointments system;

(b) succeeds to a practice where such a system is in operation; or

shall notify the Board of any appointments system which he proposes to operate or, as the case may be, of any proposal to discontinue such a system.

Employees

35

(1) A doctor shall, before employing any person to assist him in the provision of general medical services, 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.

(2) The duty imposed by paragraph (1) is in addition to the duty imposed by paragraph 27(a) so far as it relates to assistants.

(3) When considering the competence and suitability of any person for the purpose of sub-paragraph (1), a doctor shall have regard, in particular, to—

(a) that person’s academic and vocational qualifications;

(b) that person’s training and his experience in employment; and

(4) A doctor shall afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee’s competence.

Doctors' availability to patients

36

(1) Any doctor whose name is included in the medical list shall—

(a) be available normally at such times and places as, following an application by the doctor, the Board shall approve after consultation with the Local Medical Committee, or, on appeal the Department, shall determine in his case, in accordance with the requirements of the following provisions of this paragraph; and

(b) inform his patients about his availability in such manner as the Board may require in accordance with sub-paragraph (16).

(2) Subject to sub-paragraphs (3), (4), (5) and (6), the Board shall not approve any application submitted to it by a doctor in relation to the times at which he is to be available unless it is satisfied that—

(a) the times proposed are such that the doctor will normally be available—

(i) in 42 weeks in any period of 12 months;

(ii) for no less than the number of hours in any such week which are specified in relation to him under regulation 13; and

(iii) on 5 days in any such week;

(b) the hours for which the doctor will normally be available in any week shall be allocated between the days on which he will normally be available in that week in a manner likely to be convenient to his patients;

(i) another doctor whose name is included in the medical list and who is himself a full-time doctor; or

(ii) 2 job-sharing doctors whose names are included in the medical list and whose hours are aggregated for the purposes of head (d);

(d) where the doctor is a job-sharing doctor—

(i) he is practising in partnership with another doctor whose name is included in the medical list; and

(ii) the hours for which both doctors will normally be available will, in aggregate, be not less than 26 hours in any week referred to in head (a)(i).

(3) On any application made pursuant to sub-paragraph (1) by a three-quarter-time doctor or a half-time doctor—

(a) head (a)(iii) of sub-paragraph (2) shall not apply; and

(b) any approval of the application shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which that doctor ceases to satisfy sub-paragraph (2)(c).

(4) On any application made pursuant to sub-paragraph (1) by a job-sharing doctor—

(a) head (a)(iii) of sub-paragraph (2) shall apply so as to require either the job-sharing doctor or the other doctor referred to in sub-paragraph (2)(d) to be normally available on each of the days mentioned in that head; and

(b) any approval of the application shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which the doctor ceases to satisfy sub-paragraph (2)(d).

(5) On any application made pursuant to sub-paragraph (1) by a doctor who is a restricted list principal or a restricted services principal, sub-paragraph (2)(a)(i) and (iii), (c) and (d) shall not apply.

(6) The Board may, in relation to the application of any full-time doctor who seeks normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a)(i), excuse the doctor from the requirement of head (a)(iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 38.

(7) In this paragraph and in paragraph 38, “available” means, in relation to a doctor, available to provide general medical services to his patients, and for the purposes of calculating the time at which a doctor is regarded as available—

(a) account may be taken of any period when the doctor is attending at his practice premises or at any clinic provided by him for his own patients, and of any time spent making a domiciliary visit; but

(b) no account shall be taken of time spent by the doctor holding himself in readiness to make a domiciliary visit if required by any patient.

(8) An application by a doctor in relation to any place at which he is available shall not be approved by the Board unless it is satisfied that the place at which the doctor proposes to be available is likely to be convenient to his patients.

(9) An application for approval pursuant to sub-paragraph (1) shall be made in writing to the Board and shall—

(a) include the information specified in Part I of Schedule 8; and

(b) where appropriate, also include—

(i) in the case of a doctor to whom sub-paragraph (5) applies, the additional information specified in Part II of that Schedule;

(ii) in the case of a doctor to whom sub-paragraph (6) applies, the additional information specified in Part III of that Schedule.

(10) The Board shall determine an application within 28 days of receiving it.

(11) In determining any application, the Board shall either—

(a) grant approval;

(b) grant approval subject to such conditions as the Board sees fit to impose for the purpose of securing that the doctor is available at such times and places as are convenient to his patients; or

(12) Τhe Board shall notify the doctor in writing of its determination, and, where it refuses an application or grants an application subject to conditions, it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (13).

(13) A doctor may, within the period of 30 days beginning with and including the day on which the statement referred to in sub-paragraph (12) was received by him, appeal in writing to the Department against any refusal of approval or against any condition imposed pursuant to sub-paragraph (11).

(14) The Department may, when determining an appeal, either confirm the determination of the Board or substitute its own determination for that of the Board.

(15) The Department shall notify the doctor in writing of its determination and shall in every case include with the notification a written statement of the reasons for the determination.

(16) The Board may require a doctor to inform his patients, by displaying a notice at his practice premises or by sending notices to them, about the times and places at which he is available.

(17) A doctor may apply to the Board for a variation of the times and places at which, in accordance with a determination under this paragraph (“the earlier determination”), he is required to be normally available, and sub-paragraphs (2) to (15) shall apply to the making and determination (“the subsequent determination”) of an application under this sub-paragraph as if it were the first application by that doctor for the purposes of this paragraph.

(18) Where an application made under sub-paragraph (17) is granted or is granted subject to conditions, for the purposes of sub-paragraphs (1) and (16) the earlier determination mentioned in sub-paragraph (17) shall cease to have effect and the subsequent determination mentioned in that sub-paragraph shall have effect instead—

(a) where the subsequent determination is made by the Board and no appeal is made, from the day falling 8 weeks after the date on which the doctor receives notification of the Board’s determination;

(b) where the subsequent determination is made on appeal, from the day falling 8 weeks after the date on which the doctor receives notice of the determination of the appeal by the Department.

(19) Where it appears to the Board that a doctor’s hours of availability are allocated for the purposes of sub-paragraph (2)(b) in a manner which may no longer be convenient to his patients, it may, subject to sub-paragraph (26), review the terms of—

(a) any approval granted under sub-paragraph (11)(a) or (b); or

(b) any direction given under sub-paragraph (21)(a).

(20) On any review under sub-paragraph (19) the Board shall—

(a) give notice to the doctor of its proposed reallocation of his hours or availability; and

(b) allow him 30 days, beginning with and including the day on which he receives that notice, within which to make representations to the Board about its proposals.

(21) After considering any representations made in accordance with sub-paragraph (20)(b), the Board shall either—

(a) direct the doctor to revise the allocation of his hours of availability in the manner specified in the direction; or

(b) confirm that the existing allocation of the doctor’s hours of availability continues to be convenient to his patients.

(22) The Board shall notify the doctor in writing of its determination under sub-paragraph (21) and, where it gives a direction under head (a) of that sub-paragraph, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (23).

(23) A doctor may, within the period of 30 days beginning with and including the day on which the notice under sub-paragraph (22) was received by him, appeal in writing to the Department against a direction under sub-paragraph (21).

(24) Sub-paragraphs (14) and (15) shall apply to any appeal made under sub-paragraph (23).

(25) A doctor in respect of whom a direction is given under sub-paragraph (21)(a) shall revise the allocation of his hours of availability so as to give effect to the direction—

(a) where the direction is given by the Board and no appeal is made, not less than 8 weeks after the date on which he receives notification under sub-paragraph (22); or

(b) where the direction is given or confirmed on appeal, not later than 8 weeks after the date on which he receives notification of the determination of the appeal by the Department,

and the allocation of hours as so revised shall be regarded as having been approved for the purposes of sub-paragraphs (1) and (16).

(26) A Board shall not undertake a review under sub-paragraph (19) on more than one occasion in any period of 2 years.

Availability to patients outside normal hours

37

(1) Subject to the provisions of this paragraph, a doctor may apply to the Board for approval to treat patients at premises other than his practice premises outside the hours for which he is normally available pursuant to paragraph 36 (in this paragraph referred to as “normal hours”).

(2) An application under sub-paragraph (1) shall be made in writing and shall state the address of the premises in respect of which the application is made.

(3) An application under sub-paragraph (1) shall not be approved by the Board unless it is satisfied that, having regard to—

(i) the fact that the premises are for the treatment of patients outside normal hours; and

(ii) all other relevant circumstances,

the premises to which the application relates are likely to be reasonably convenient to the doctor’s patients.

(4) Sub-paragraphs (10) to (15) of paragraph 36 shall apply to an application under sub-paragraph (1) as they apply to an application under paragraph 36(1).

(5) Where the Board determines an application under sub-paragraph (1) by granting approval (with or without conditions), the doctor shall inform his patients by displaying a notice at his practice premises, stating the address of the premises for which approval has been granted.

(6) A doctor may apply to the Board for a variation of any approval granted under this paragraph, and such application shall be made and determined as if it were the first application for the purposes of this paragraph.

(7) Where it appears to the Board that premises which it has approved under this paragraph may no longer be reasonably convenient to the doctor’s patients, it may give notice to the doctor that it proposes to review the terms of the approval.

(8) On any review under sub-paragraph (7), the Board shall allow the doctor a period of 30 days, beginning with and including the date on which he receives the notice, within which to make representations to the Board about its proposals.

(9) After considering any representations made in accordance with sub-paragraph (8), the Board may determine to—

(a) continue its approval;

(b) continue its approval subject to such new or varied conditions as it sees fit to impose; or

(10) The Board shall notify the doctor in writing of its determination under sub-paragraph (9); and where it determines to withdraw its approval or to continue it subject to new or varied conditions, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (11).

(11) A doctor may, within the period of 30 days beginning with and including the date on which he receives the notice referred to in sub-paragraph (10), appeal in writing to the Department against the withdrawal of approval or against any condition imposed pursuant to sub-paragraph (9); and sub-paragraphs (14) and (15) of paragraph 36 shall apply to any such appeal as they apply to an appeal under that paragraph.

Doctors available for only 4 days a week

38

(1) Subject to sub-paragraph (3), where the Board is satisfied that, by reason of a doctor’s participation in health-related activities (other than the provision of general medical services to his patients), he would be likely to suffer an unreasonable degree of inconvenience if paragraph 36(2)(a)(iii) applied in his case, it may give its approval for the doctor normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a) of that paragraph.

(2) For the purposes of sub-paragraph (1), “health-related activities” means activities connected with—

(a) the organisation of the medical profession or the training of its members;

(b) the provision of medical care or treatment;

(d) the administration of services under Part II of the Order or of arrangements pursuant to Article 56 of the Order[^f00043] for the provision of general medical services,

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