The National Health Service (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1989

Made: 15th October 1989

Laid before Parliament: 16th October 1989

Coming into force in accordance with regulation 1(2)

The Secretary of State for Health, in exercise of powers conferred by sections 15(1)(b), 29, 41, 42, 126(1) and (4), 127(a) and 128(1) of, and paragraph 10(1) of Schedule 5 to, the National Health Service Act 1977[^f00001] and section 8 of the Health and Medicines Act 1988[^f00002], and of all other powers enabling him in that behalf, and after consultation with the Council on Tribunals pursuant to section 10(1) of the Tribunals and Inquiries Act 1971[^f00003], hereby makes the following Regulations:

Citation, commencement and interpretation

1

• (1) These Regulations may be cited as the National Health Service (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1989.

• (2) These Regulations shall come into force–

• (a) for the purposes of regulations 1, 5(c), 6, 7, 14, 16, 18, 21(a) (to the extent that it relates to paragraph 11 of Schedule 1) and 24(3), on 7th November 1989;

• (b) for the purposes of regulation 23, on 1st December 1989;

• (c) for the purposes of regulations 3(b) (to the extent that it relates to paragraph 25 of Schedule 1, and to Schedule 1C, to the principal Regulations), 4 (to the extent that it inserts regulations 3A(1) to (10) and (16) and 3B(1) to (10) and (16) into the principal Regulations), 21(a) (to the extent that it relates to paragraph 9 of Schedule 1) and (c) and 22 (to the extent that it relates to Schedule 6), on 1st January 1990;

• (d) for all other purposes, on 1st April 1990.

• (3) In these Regulations “the principal Regulations” means the National Health Service (General Medical and Pharmaceutical Services) Regulations 1974[^f00004].

Amendment of regulation 2 of the principal Regulations

2

In regulation 2(1) of the principal Regulations (interpretation)–

• (a) the following definitions shall be inserted at the appropriate places in the alphabetical order–

• “child” means a person who has not attained the age of 16 years;
• “child health surveillance list” shall be construed in accordance with regulation 3A(1);
• “child health surveillance services” means the personal medical services described in paragraph 9B of the terms of service and Schedule 1A to these Regulations;
• “domiciliary visit” means a visit to either the place where the patient resides or the place, other than the doctor’s practice premises, where the doctor is obliged, pursuant to paragraph 13A of the terms of service, to render personal medical services to the patient;
• “group practice” means an association of not less than two doctors both or all of whom– have their names included in the Committee’s medical list; co-ordinate, in the course of regular contact between them, their respective obligations under the terms of service for doctors to provide personal medical services to their patients; and conduct and manage their practices from at least one common set of practice premises;
• “Local Directory” means the Local Directory of Family Doctors maintained by a Committee pursuant to regulation 5A;
• “medical records” means, in relation to any patient, the records maintained in respect of that patient pursuant to paragraph 30 of the terms of service;
• “minor surgery list” shall be construed in accordance with regulation 3B(1);
• “minor surgery services” means the personal medical services described in paragraph 9C of the terms of service and Schedule 1B to these Regulations;
• “parent” includes any adult person who, in the opinion of the doctor, is for the time being fulfilling the obligations normally attaching to a parent in respect of his child;
• “practice premises” means, in relation to any doctor, the premises at which he is obliged under the terms of service to attend at specified times in order to be consulted by, or to provide treatment or services for, his patients;
• “restricted list principal” means a doctor who has undertaken to provide general medical services only to a restricted category of patients identified by reference to their connection with a particular establishment or organisation;
• “restricted services principal” means a doctor who has undertaken to the Committee to provide general medical services limited to– child health surveillance services; contraceptive services; maternity medical services; or minor surgery services, or to any combination of the above;
• “the Tribunal” means the Tribunal constituted under section 46 of the National Health Service Act 1977[^f00005];

• (b) in the definition of “treatment”–

• (i) for the words “contraceptive services or maternity medical services” there shall be substituted the words “child health surveillance services, contraceptive services, maternity medical services or minor surgery services”,

• (ii) for the word “woman” there shall be substituted the word “person”.

Amendment of regulation 3 of the principal Regulations

3

In regulation 3 of the principal Regulations (scope of services)–

• (a) after sub-paragraph (b) there shall be inserted the following sub-paragraph:–

(bb) the provision by doctors of child health surveillance services and minor surgery services;

• (b) in paragraph (2) after the words “terms of service” there shall be added the words “, and Schedules 1C, 1D and 1E to these Regulations shall have effect for the purposes of paragraphs 25, 38B and 43A respectively of the terms of service.”.

Insertion of new regulations 3A and 3B into the principal Regulations

4

After regulation 3 of the principal Regulations there shall be inserted the following regulations:–

(3A) (1) The Committee shall, on and after 1st April 1990, maintain a list (in these Regulations referred to as “a child health surveillance list”) of the names of those doctors who have satisfied the Committee or, on appeal, the Secretary of State, in accordance with the following provisions of this regulation, that they have such medical experience and training as are necessary to enable them properly to provide child health surveillance services. (2) A doctor may apply, in accordance with paragraph (3), to a Committee for the inclusion of his name in the child health surveillance list required to be maintained by that Committee. (3) An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part IV of Schedule 1 to these Regulations. (4) Unless the doctor otherwise agrees, the Committee shall determine an application made in accordance with paragraph (3) within 2 months of receiving it. (5) The Committee may, if it thinks fit, hold an oral hearing of any application and shall not refuse an application without giving the doctor an opportunity of an oral hearing. (6) When determining an application the Committee shall have regard in particular to– (a) any training undertaken by the doctor; and (b) any medical experience gained by him, during the period of five years immediately preceding the date of the application, which is relevant to the provision of child health surveillance services, and shall seek and take into account any medical advice it considers necessary to enable it to determine the application. (7) The Committee shall determine an application by either– (a) granting the application; or (b) refusing the application. (8) The Committee shall give notice in writing to the doctor of its determination and shall– (a) where it refuses the application, inform him of the reasons for the determination and of his right of appeal under paragraph (9); (b) where it grants the application, include the doctor’s name in its child health surveillance list. (9) If an application is refused the doctor may appeal in writing to the Secretary of State within 90 days of receiving notice in writing of the Committee’s determination. (10) On any appeal pursuant to paragraph (9), the Secretary of State– (a) may, if he thinks fit, hold an oral hearing of the appeal; (b) in determining the appeal, shall either confirm or reverse the determination of the Committee; (c) where he reverses the determination of the Committee, shall direct that the Committee include the doctor’s name in its child health surveillance list. (11) Subject to paragraphs (12) to (16), a doctor’s name may be removed by the Committee from the child health surveillance list only if– (a) it has been removed from the medical list of any Committee pursuant to regulation 5(1) or 5B; (b) the Committee has determined that the doctor has not provided child health surveillance services at any time during the past 5 years; (c) the Committee has determined that the doctor has, in relation to any patient in respect of whom he has undertaken to provide child health surveillance services, failed, in a material respect, to comply with any requirement of paragraph 9B of the terms of service or Schedule 1A to these Regulations; or (d) the Committee has determined that the doctor is no longer able to provide child health surveillance services. (12) Before making any determination under sub-paragraph (b), (c) or (d) of paragraph (11) the Committee shall– (a) give the doctor 28 days' written notice of its intention to do so, and (b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the Committee. (13) Where the Committee makes a determination under sub-paragraph (b), (c) or (d) of paragraph (11), it shall send to the doctor a notice which shall include a statement– (a) to the effect that, subject to any appeal under paragraph (14), the doctor’s name will, after 28 days from the date of notice, be removed from the child health surveillance list maintained by the Committee; (b) of the Committee’s reasons for its determination; and (c) of the doctor’s right of appeal under paragraph (14). (14) A doctor who has received a notice sent in accordance with paragraph (13) may, within 21 days of receiving it, appeal to the Secretary of State against the determination of the Committee, and pending the determination of the appeal the Committee shall not remove his name from the child health surveillance list. (15) An appeal to the Secretary of State shall be made in writing and shall include a statement of the facts and contentions on which the doctor intends to rely; and on any such appeal the Secretary of State shall, if he allows the appeal, direct that the Committee shall not remove the doctor’s name from the child health surveillance list. (16) The Committee shall comply with any direction given to it under this regulation. (3B) (1) The Committee shall, on and after 1st April 1990 maintain a list (in these Regulations referred to as “the minor surgery list”) of the names of those doctors who have satisfied the Committee or, on appeal, the Secretary of State in accordance with the following provisions of this regulation that they have such medical experience, training and facilities as are necessary to enable them properly to provide minor surgery services. (2) A doctor may apply, in accordance with paragraph (3), to a Committee for the inclusion of his name in the minor surgery list required to be maintained by that Committee. (3) An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part V of Schedule 1 to these Regulations. (4) Unless the doctor otherwise agrees, the Committee shall determine an application made in accordance with paragraph (3) within 2 months of receiving it. (5) The Committee may, if it thinks fit, hold an oral hearing of any application and shall not refuse an application without giving the doctor an opportunity of an oral hearing. (6) When determining an application the Committee shall have regard in particular– (a) for the purpose of assessing the doctor’s medical experience, to any– (i) postgraduate qualification held by him, (ii) training undertaken by him; and (iii) medical experience gained by him, during the period of five years immediately preceding the date of the application, which is relevant to the provision of minor surgery services; (b) for the purpose of assessing the doctor’s facilities, to the premises and the equipment to be used by the doctor in the provision of minor surgery services, and shall seek and take into account any medical advice it considers necessary to enable it to determine the application. (7) The Committee shall determine an application by either– (a) granting the application; or (b) refusing the application. (8) The Committee shall inform the doctor in writing of its determination and shall– (a) where it refuses the application, give notice in writing to him of the reasons for the determination and of his right of appeal under paragraph (9); (b) where it grants the application, include the doctor’s name in its minor surgery list. (9) If an application is refused the doctor may appeal in writing to the Secretary of State within 90 days of receiving notice in writing of the Committee’s determination. (10) On any appeal pursuant to paragraph (9), the Secretary of State– (a) may, if he thinks fit, hold an oral hearing of the appeal; (b) in determining the appeal, shall either confirm or reverse the determination of the Committee; (c) where he reverses the determination of the Committee, shall direct that the Committee include the doctor’s name in its minor surgery list. (11) Subject to paragraphs (12) to (16), a doctor’s name may be removed from the minor surgery list only if– (a) it has been removed from the medical list of any Committee pursuant to regulation 5(1) or 5B; (b) the Committee has determined that the doctor has not provided minor surgery services at any time during the past 5 years; (c) the Committee has determined that the doctor has, in relation to any patient in respect of whom he has undertaken to provide minor surgery services, failed, in a material respect, to comply with any requirement of paragraph 9C of the terms of service or Schedule 1B to these Regulations; or (d) the Committee has determined that the doctor is no longer able to provide minor surgery services. (12) Before making any determination under sub-paragraph (b), (c) or (d) of paragraph (11) the Committee shall– (a) give the doctor 28 days' written notice of its intention to do so; and (b) afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the Committee. (13) Where the Committee makes a determination under sub-paragraph (b), (c) or (d) of paragraph (11), it shall send to the doctor a notice which shall include a statement– (a) to the effect that, subject to any appeal under paragraph (14), the doctor’s name will, after 28 days from the date of the notice, be removed from the minor surgery list maintained by the Committee; (b) of the Committee’s reasons for its determination; and (c) of the doctor’s right of appeal under paragraph (14). (14) A doctor who has received a notice sent in accordance with paragraph (13) may, within 21 days of receiving it, appeal to the Secretary of State against the determination, and pending the determination of the appeal the Committee shall not remove his name from the minor surgery list. (15) An appeal to the Secretary of State shall be made in writing and shall include a statement of the facts and contentions on which the doctor intends to rely; and on any such appeal the Secretary of State shall, if he allows the appeal, direct that the Committee shall not remove the doctor’s name from the minor surgery list. (16) The Committee shall comply with any direction given to it under this regulation.

Amendment of regulation 4 of the principal Regulations

5

In regulation 4 of the principal Regulations (medical list)–

• (a) in paragraph (2)–

• (i) after sub-paragraph (a) there shall be inserted the following sub-paragraph:–

(aa) whether his name is included in either or both of the child health surveillance list and the minor surgery list;

• (ii) in sub-paragraph (c), after “terms of service” there shall be inserted “as in force immediately prior to 1st April 1990”;

• (iii) after sub-paragraph (d) there shall be added the following sub-paragraph:–

(e) if he is a restricted list principal or a restricted services principal.

• (b) in paragraph (4)–

• (i) after sub-paragraph (d) there shall be inserted the following sub-paragraph–

(dd) where he participates in a group practice, the name of each other doctor in that group practice;

• (ii) in sub-paragraph (e) immediately before “any conditions” there shall be inserted “an indication of the geographical boundary of his practice area by reference to a map of a scale approved by the Committee, and”;

• (iii) after sub-paragraph (e) there shall be inserted the following sub-paragraph:–

(f) provided that the doctor consents to its inclusion, his date of birth, or, if he does not so consent, the date of his first full registration as a medical practitioner (whether pursuant to the Medical Act 1983[^f00006] or otherwise);

• (c) after paragraph (4) there shall be inserted the following paragraph:–

(5) Without prejudice to the provisions of regulation 6(1), a doctor whose name is included in the medical list of any Committee– (a) who is requested in writing by the Committee by no later than 1st December 1989 to supply information about any matter referred to in paragraph (4), shall supply that information to the Committee by 1st January 1990; (b) who participates in a group practice, shall furnish the Committee with the name of each other doctor in the group practice by 1st January 1990.

Amendment of regulation 5 of the principal Regulations

6

In regulation 5(1) of the principal Regulations (removal from the medical list)–

• (a) at the end of sub-paragraph (c) there shall be added the word “or”;

• (b) after sub-paragraph (c) there shall be inserted the following sub-paragraph:—

(d) is the subject of a direction by the Tribunal requiring the removal of his name from the medical list of the Committee,

Insertion of regulations 5A and 5B into the principal Regulations

7

After regulation 5 of the principal Regulations there shall be inserted the following regulations:–

(5A) (1) Subject to the requirements of this regulation and regulation 6A, the Committee shall, by 1st April 1990, prepare, and thereafter maintain, in addition to a medical list, a list to be known as the Local Directory of Family Doctors (in these Regulations called a “Local Directory”) comprising, in respect of each doctor whose name is included in its medical list, the following information:– (a) all the information included in respect of the doctor in the medical list of the Committee, other than– (i) information included pursuant to regulation 4(2)(c); and (ii) his date of birth, unless the doctor has agreed to its inclusion in the Local Directory; (b) where the doctor’s date of birth is included in the medical list but he has not agreed to its inclusion in the Local Directory, the date of his first full registration as a medical practitioner (whether pursuant to the Medical Act 1983 or otherwise); (c) the sex of the doctor; (d) details of any medical qualification held by the doctor which he is entitled to have registered pursuant to section 16 of the Medical Act 1983 (registration of qualifications), including the date on which the qualification was awarded; (e) the nature of any clinic provided by the doctor for his patients and the frequency with which it is held; (f) the numbers of assistants and trainee general practitioners employed by him; (g) details of– (i) the number of other persons employed or available at his practice premises to assist him in the discharge of his obligations under the terms of service, (ii) the nature of the services provided by each such person, and (iii) the average number of hours normally worked by each such person during each week; (h) the terms of any consent granted to the doctor by the Committee or, on appeal, by the Secretary of State, pursuant to paragraph 19 of the terms of service, concerning the use of a deputising service; and (j) where, and to the extent that, the doctor so requests– (i) details of any languages, other than English, spoken by the doctor or by any person referred to in sub-paragraph (f) or (g), (ii) details of any particular clinical interests of the doctor. (2) Paragraph (1) shall apply in the case of a restricted list principal or a restricted services principal only to the extent that the Committee sees fit. (3) The Committee may, to the extent that it sees fit, also include in the Local Directory other details or material relating to general medical services, general dental services, general ophthalmic services and pharmaceutical services in its locality under Part II of the National Health Service Act 1977. (4) A doctor shall, in respect of each Local Directory in which information about him is to be recorded, furnish the Committee by 1st January 1990 with so much of the information specified in sub-paragraphs (b) to (h) of paragraph (1) as may be requested by the Committee before 1st December 1989. (5) The Local Directory shall include the name of each doctor in alphabetical order. (6) Where a doctor practises in partnership or in a group practice with other doctors, the information regarding his practice which falls to be included in the Local Directory pursuant to paragraph (1)(e), (f), (g) and (j)(i) may, provided each doctor in the partnership or, as the case may be, the group practice agrees, be included in the entry relating to only one of those doctors. (7) Notwithstanding the provisions of regulation 31, the Committee may compile extracts from the information in the Local Directory by reference to geographical areas of the Committee’s locality, and may make any such extract available to persons to whom, in the opinion of the Committee, it is likely to be of interest. (5B) (1) A Committee shall, on 1st April 1991, remove from the medical list the name of any doctor who has, on or before that date, attained the age of 70 years. (2) Where, on any day after 1st April 1991, a doctor whose name is included in the medical list attains the age of 70 years, the Committee shall thereupon remove his name from the list. (3) A Committee shall give to any doctor whose name is to be removed from the medical list in accordance with paragraph (1) or (2)– (a) notice in writing to that effect not less than 12 months nor more than 13 months before the date on which his name is to be removed; (b) a further such notice not less than 3 months nor more than 4 months before that date, but the failure to give notice to any doctor as required by sub-paragraph (a) or (b) shall not prevent the removal of that doctor’s name from the medical list in accordance with paragraph (1) or (2). (4) A doctor shall, for the purposes of this regulation, supply to the Committee by 1st February 1990 such evidence of his date of birth as the Committee may, by 1st January 1990, have in writing required from him.

Amendment of regulation 6 of the principal Regulations

8

In regulation 6 of the principal Regulations (amendment of or withdrawal from the medical list) for paragraphs (1) and (2) there shall be substituted the following paragraphs:–

(1) A doctor shall, unless it is impractical for him to do so, notify the Committee within 28 days of any occurrence requiring a change in the information recorded about him in the medical list. (2) A doctor shall, unless it is impractical for him to do so, notify the Committee in writing at least 3 months in advance of any date on which he intends either– (a) to withdraw his name from any of the medical list, the child health surveillance list, the obstetric list or the minor surgery list; or (b) to cease to provide any of the following services, or to provide general medical services limited to any of the following services (or any combination of them), namely child health surveillance services, contraceptive services, maternity medical services, or minor surgery services. (2A) The Committee shall– (a) on being notified by any doctor pursuant to paragraph (1), amend the medical list in relation to that doctor; (b) in the case of a notification pursuant to paragraph (2), so amend the medical list either– (i) on the date which falls 3 months after the date of the notification; or (ii) the date from which the Committee has agreed that the withdrawal or cessation shall take effect, whichever is the earlier.

Insertion of regulation 6A in the principal Regulations

9

After regulation 6 of the principal Regulations there shall be inserted the following regulation:–

(6A) (1) A doctor shall, unless it is impractical for him to do so, notify the Committee within 28 days of any occurrence requiring a change in the information recorded about him in the Local Directory. (2) The Committee shall, in the event of a notification pursuant to paragraph (1), make any necessary amendment to the Local Directory.

Amendment of regulation 7 of the principal Regulations

10

In regulation 7 of the principal Regulations (application for inclusion in the medical list or to succeed to a vacancy)–

• (a) in paragraph (1) for the words “from the application” to “set out” there shall be substituted the words “by post to the Committee an application in writing which shall include the information and undertakings specified”;

• (b) in paragraph (2) for the words “in the form set out” there shall be substituted the words “and shall include the information and undertakings specified”.

Amendment of regulation 14 of the principal Regulations

11

In regulation 14 of the principal Regulations (application for acceptance by a doctor) after paragraph (2) there shall be added the following paragraphs:–

(3) A parent may, in relation to a child of his who is under the age of 5 years, apply to a doctor– (a) who is– (i) the doctor on whose list the child is included (in this paragraph referred to as “the child’s doctor”), (ii) a doctor with whom the child’s doctor is in partnership, or (iii) a doctor with whom the child’s doctor is associated in a group practice; and (b) whose name is included in any medical list and in the child health surveillance list of the Committee, for the provision of child health surveillance services in respect of that child for a period ending on the date on which that child attains the age of 5 years. (4) A person may apply to a doctor– (a) who is– (i) the doctor on 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 any medical list and the minor surgery list of the Committee, for the provision of a procedure specified in Schedule 1B to these Regulations.

Amendment of regulation 16 of the principal Regulations

12

In regulation 16 of the principal Regulations (assignment of persons to doctors), in paragraph (1) after head (i) of the proviso there shall be inserted the following head:–

(ia) a doctor shall not be required to provide either child health surveillance services or minor surgery services for a patient assigned to him under this paragraph unless, following an application pursuant to regulation 14(3) or (4) respectively, he has accepted that patient for the provision of such services;

Amendment of regulation 17 of the principal Regulations

13

In regulation 17 of the principal Regulations (limitation of number of persons on doctors' lists)–

• (a) the words in paragraph (1) from “For the purposes” to the end of the paragraph shall be deleted;

• (b) after paragraph (1) there shall be inserted the following paragraph:–

(1A) For the purpose of determining under paragraph (1) the number of persons a doctor may have on his list, a doctor who is in partnership shall be treated as an assistant, and not a partner, unless the Committee or, on appeal, the Secretary of State is satisfied that he– (a) discharges the duties and exercises the powers of a principal in connection with the practice of the partnership; and, (b) either– (i) in the case of a doctor whose approved hours are not less than 26 hours per week, he is entitled to a share of the profits which is not less than one third of the share of the partner with the greatest share, or (ii) in the case of a doctor whose approved hours are less than 26 hours per week but not less than 19 hours per week he is entitled to a share of the profits which is not less than one quarter of the share of the partner with the greatest share; or (iii) in the case of a doctor whose approved hours are less than 19 hours per week but not less than 13 hours per week he is entitled to a share of the profits which is not less than one fifth of the share of the partner with the greatest share.

• (c) after paragraph (7) there shall be added the following paragraph:–

(8) In this regulation, “approved hours” means, in relation to any doctor, the period approved by the Committee in his case, pursuant to paragraph 25 of the terms of service, during which he is normally to be available to his patients.

Amendment of regulation 18 of the principal Regulations

14

In regulation 18 of the principal Regulations (change of doctor) for paragraphs (1), (2) and (3) there shall be substituted the following paragraphs:–

(1) Subject to the requirements of paragraph (2), a person who is on a doctor’s list of patients may apply to any other doctor providing general medical services for acceptance on that other doctor’s list of patients. (2) An application pursuant to paragraph (1) shall be made in accordance with regulation 14(1). (3) A person who has applied pursuant to paragraph (1) to, and been refused acceptance by, any doctor may apply to the Committee in whose locality he resides for assignment to a doctor whose name is included in the Committee’s medical list.

Amendment of regulation 19 of the principal Regulations

15

In regulation 19 of the principal Regulations (temporary provision of general medical services) in paragraph (13) for the words after “to provide” to the end of the paragraph there shall be substituted the following words:–

child health surveillance services, contraceptive services, maternity medical services or minor surgery services which he has not undertaken to provide.

Amendment of regulation 23 of the principal Regulations

16

In regulation 23 of the principal Regulations (application for maternity medical services) for paragraph (2) there shall be substituted the following paragraphs:–

(2) A woman who has arranged with a doctor (in this regulation referred to as “the original doctor”) for the provision of maternity medical services may terminate the arrangement– (a) by so informing the Committee in writing; (b) by so informing in writing the original doctor who shall within 7 days notify the Committee in writing; or (c) by making a new arrangement with another doctor who shall within 7 days notify the Committee in writing of the new arrangement. (3) Where a Committee receives notification in accordance with paragraph (2)(a) or (c) it shall within 7 days notify the original doctor in writing that the woman’s arrangement with him has been terminated.

Amendment of regulation 24 of the principal Regulations

17

In regulation 24(1) of the principal Regulations (payments to doctors)–

• (a) for sub-paragraph (a) there shall be substituted the following sub-paragraph:–

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

• (b) in sub-paragraph (b) the words “and supplementary” shall be deleted;

• (c) in sub-paragraph (e) the words “for post-graduate training,” shall be deleted;

• (d) in sub-paragraph (g) the words after “practice expenses” to the end of the sub-paragraph shall be deleted;

• (e) after sub-paragraph (k) the following sub-paragraphs shall be inserted:–

(l) capitation fees in respect of patients who participate in a consultation pursuant to paragraph 13B of the terms of service; (m) capitation fees in respect of patients to whom child health surveillance services are provided; (n) capitation fees in respect of patients living in deprived areas; (o) fees for minor surgery sessions undertaken; (p) fees in respect of the provision of health promotion clinics approved by the Committee; (q) target payments in respect of immunisations provided; (r) target payments in respect of cervical cytology; (s) allowances for the employment of locums by doctors during confinement, sickness or study leave; (t) allowances for undergoing approved postgraduate education; (u) allowances for the employment of doctors by isolated single-handed doctors; (v) allowances in respect of providing placements in the practice for undergraduate medical students; (w) transitional payments in consequence of changes to doctors' terms of service,

Amendment of regulation 25 of the principal Regulations

18

In regulation 25(3) of the principal Regulations (definition of “supplemental services” in chemists' terms of service)–

• (a) in sub-paragraph (a) for the words “registered under the Registered Homes Act 1984[^f00007]” there shall be substituted the words “in respect of which a person is registered under Part I of the Registered Homes Act 1984 or in respect of which registration is, by virtue of section 1(5)(j) of that Act, not required”;

• (b) for sub-paragraph (c) there shall be substituted the following sub-paragraph:–

(c) the keeping of records in connection with drugs supplied to any person– (i) who claims exemption under regulation 6(1)(c) of the National Health Service (Charges for Drugs and Appliances) Regulations 1989[^f00008] (remission from charges for drugs and appliances), or (ii) who, in the opinion of the pharmacist supplying the drug, is likely to have difficulty understanding the nature and dosage of the drug supplied and the times at which it is to be taken, in circumstances where the nature of the drug is such that, in the opinion of the pharmacist supplying it, the same or a similar drug is likely to be prescribed for that person regularly on future occasions.

Amendment of regulation 31 of the principal Regulations

19

In regulation 31 of the principal Regulations (publication of particulars) in paragraph (1) the following sub-paragraphs shall be added after sub-paragraph (g):–

(h) the Local Directory; (i) a compendium of practice leaflets provided to it by doctors whose names are included in its medical list;

Insertion of regulations 33A and 33B in the principal Regulations

20

After regulation 33 of the principal Regulations there shall be inserted the following new regulations:–

(33A) The Committee shall appoint a doctor to assist it in the exercise of its functions pursuant to paragraph 39A of the terms of service for doctors (inquiries about prescriptions and referrals). (33B) A Committee may issue guidance to doctors whose names are included in its medical list to assist them in assessing in accordance with paragraph 24A of the terms of service the qualifications, experience and competence of any employee, or prospective employee, provided that such guidance has regard as appropriate to standards adopted by any appropriate national regulatory body for a profession or occupation or similar body.

Amendment of Schedule 1 to the principal Regulations

21

In Schedule 1 to the principal Regulations–

• (a) Part I (terms of service for doctors) shall be amended in accordance with Schedule 1 to these Regulations;

• (b) for Parts II and III (forms of application for inclusion in a medical list and for filling a vacancy) there shall be substituted the Parts set out in Parts I and II respectively of Schedule 2 to these Regulations;

• (c) after Part III there shall be added the new Parts IV and V set out in Schedule 3 to these Regulations.

Insertion of new Schedules in the principal Regulations

22

After Schedule 1 to the principal Regulations there shall be inserted the new Schedules 1A, 1B, 1C, 1D and 1E set out respectively in Schedules 4, 5, 6, 7 and 8 to these Regulations.

Amendment of Schedule 3A to the principal Regulations

23

In Schedule 3A to the principal Regulations (drugs and other substances not to be prescribed for supply under pharmaceutical services)–

• (a) the following entry shall be omitted:–

• Ener-G Gluten-free and Yeast-free Brown Rice Bread

• (b) the following entries shall be inserted at the appropriate places in the alphabetical order:–

• Alexitol Sodium Tablets
• Anadin Paracetamol Tablets
• Aspirin Tablets, Effervescent Soluble
• Aspro Clear Extra Tablets
• Banimax Tablets
• Boots Hard Lens Wetting Solution
• Calamage
• Colgate Disclosing Tablets
• Contactasol 02 Care Solution
• Contactasol Complete Care all-in-one Solution
• Cow and Gate Premium Baby Food
• Evident Disclosing Cream
• Ferrol
• Innoxa Finishing Touch Loose Powder
• Innoxa Moisturised Liquid Make-Up
• Lucozade
• Milupa Aptamil Baby Milk
• Milupa Camomile Infant Drink
• Milupa Fennel Variety Infant Drink
• Milupa Modified Yoghurt
• Minoxidil Cream
• Minoxidil Ointment
• Minoxidil Solution (for external use)
• Oral B Plaque Check Disclosing Tablets
• Rabenhorst Tomato Juice
• Ribena
• RoC Eye Make-Up Remover Lotion
• Senlax Tablets
• Setlers Extra Strength Tablets

Transitional provisions

24

• (1) Subject to paragraph (2), where, on or after the date on which regulation 17 of these Regulations comes into force, there falls to be determined an application by a doctor for a payment arising pursuant to a provision of regulation 24(1) of the principal Regulations which has been amended by that regulation 17, the application shall be determined as if that provision had not been so amended.

• (2) Paragraph (1) shall not apply in relation to any application received by the Committee after 31st March 1991.

• (3) Until 1st April 1990 regulation 4(5) of the principal Regulations shall have effect as if the reference in that paragraph to “any matter referred to in paragraph (4)” included a reference to a matter to be inserted in that paragraph (4) by virtue of regulation 5(b)(ii) and (iii) of these Regulations.

SCHEDULE 1 — AMENDMENTS TO PART I OF SCHEDULE 1 TO THE PRINCIPAL REGULATIONS

(TERMS OF SERVICE FOR DOCTORS)

1

For paragraph 3 (general) there shall be substituted the following paragraph:–

(3) Where a decision whether any, and if so what, action is to be taken under these terms of service requires the exercise of professional judgment, 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 paragraph 9B or minor surgery services under paragraph 9C, that which any general practitioner included 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 practitioners as a class may reasonably be expected to exercise.

2

In paragraph 4 (a doctor’s patients) for the words “under paragraph 8” in sub-paragraph (1)(g), there shall be substituted the words “under paragraph 8, 9B or 9C”.

3

After paragraph 9 there shall be inserted the following paragraphs–

(9A) A doctor whose name is included in the medical 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 a group practice, undertake to provide– (a) child health surveillance services, provided that– (i) his name is also included in the child health surveillance list, and (ii) the person in question is a child who is under the age of 5 years; (b) minor surgery services, provided that his name is included in the minor surgery list. (9B) A doctor who has undertaken, pursuant to paragraph 9A(a), to provide child health surveillance services to any child shall, in respect of that child– (a) provide all the services described in paragraph 1 of Schedule 1A to these Regulations, other than any examination so described which the parent refuses to allow the child to undergo, until the date upon which the child attains the age of 5 years; (b) maintain such records as are specified in paragraph 2 of that Schedule; and (c) furnish the relevant health authority with such information as is specified in paragraph 3 of that Schedule in accordance with the requirements of that paragraph. (9C) (1) A doctor who has undertaken, pursuant to paragraph 9A(b), to provide minor surgery services in respect of any patient shall offer to provide any of the procedures described in Schedule 1B to these Regulations which it is, in his opinion, appropriate for him to provide in the case of that patient. (2) 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.

4

After paragraph 12 there shall be inserted the following paragraph:–

(12A) (1) An undertaking referred to in paragraph 9A(a) shall cease forthwith to be effective if– (a) either– (i) the parent informs the doctor, or (ii) the doctor informs the parent, that he wishes the undertaking to have no further effect; (b) the child has been removed from the doctor’s list, from that of his partner or from that of a doctor with whom he is associated in a group practice, as the case may be, and has not been transferred to any other of those lists; (c) the parent– (i) has been invited to arrange for the child to attend for an examination referred to in paragraph 1(b) of Schedule 1A to these Regulations, and (ii) fails within 42 days to respond to that invitation; or (d) any examination referred to in paragraph 1(b) of that Schedule is undertaken in respect of the child otherwise than by the doctor or a person acting on his behalf. (2) Where, in accordance with sub-paragraph (1), an undertaking referred to in paragraph 9A(a) has ceased to be effective, the doctor shall forthwith– (a) in a case to which any of heads (a), (c) or (d) of that sub-paragraph applies, so inform the Committee in writing; and (b) in a case to which either head (c) or (d) of that sub-paragraph applies, also so inform the parent in writing.

5

For paragraph 13 (service to patients) there shall be substituted the following paragraphs:–

(13) (1) Subject to paragraphs 3, 13A and 36A, a doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general medical 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 and 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, where appropriate, vaccination or immunisation against Measles, Mumps, Rubella, Pertussis, Poliomyelitis, Diphtheria and Tetanus; (d) arranging for the referral of patients, as appropriate, for the provision of any other services under the National Health Service Act 1977[^f00009]; (e) giving advice, as appropriate, to enable patients to avail themselves of services provided by a local social services authority. (3) A doctor is not required by sub-paragraph (1) or (2)– (a) to provide to any person contraceptive services, child health surveillance services, minor surgery services nor, except in an emergency, maternity medical services, unless he has previously undertaken to the Committee to provide such services to that person; or (d) where he is a restricted services principal, to provide any category of general medical services which he has not undertaken to provide. (13A) (1) The services referred to in paragraph 13 shall be rendered by a doctor– (a) at his practice premises; or (b) if the condition of the patient so requires– (i) at the place where the patient was residing when he was accepted by the doctor pursuant to paragraph 6 or, as the case may be, when he was assigned to the doctor pursuant to regulation 16, 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, or (ii) at such other place as the doctor has informed the patient and the Committee is the place where has agreed to visit and treat the patient if the patient’s condition so requires; or (iii) in any other case, at some other place in the doctor’s practice area. (2) Without prejudice to the generality of sub-paragraph (1) a doctor shall in particular make himself available for consultations at such places and at such times as have been approved by the Committee in his case, pursuant to paragraph 25. (13B) (1) Subject to sub-paragraphs (4) to (9), where a patient has been accepted on a doctor’s list under paragraph 6 or assigned to a doctor’s list under regulation 16, 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 13A(1)(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 height, weight and blood pressure, and (ii) the taking of a urine sample and its analysis to identify the presence of albumin and glucose; (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; and (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, the 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 where a doctor invites a patient or parent to participate in a consultation pursuant to 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 parent at the address recorded in his medical records as being his last home address; (b) record in the patient’s medical records the date of each such invitation and whether or not it was accepted; (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 his medical records, advise the Committee accordingly. (4) A doctor shall not be obliged to offer a consultation pursuant to sub-paragraph (1)– (a) if he is a restricted services principal; (b) in respect of a child under the age of 5 years; (c) to any patient who, immediately before joining the list of the doctor, was a patient of a partner of the doctor and who, during the 12 months immediately preceding the date of his acceptance or assignment to the doctor’s list, had participated in a consultation pursuant to sub-paragraph (1); or (d) to the extent allowed by the Committee, to any patient within a class of patients in respect of which the Committee or, on appeal, the Secretary of State has, pursuant to sub-paragraphs (5) to (8), 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 Committee 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 pursuant to sub-paragraph (1) by the end of the period of the deferment. (7) Within 2 months of receiving an application the Committee shall determine it– (a) by approving the application; (b) by approving the application subject to conditions; or (c) by refusing the application. (8) A doctor may appeal in writing to the Secretary of State against any refusal of an application, or against any condition subject to which an application is approved by a Committee pursuant to sub-paragraph (7)(b) and on determining such an appeal the Secretary of State shall either confirm the Committee’s determination or substitute his own determination for that of the Committee. (9) The Secretary of State shall notify the doctor in writing of his determination and shall include with the notice a statement of his reasons for the determination. (13C) (1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligation under these terms of service, invite each patient on his list who appears to him– (a) to have attained the age of 16 years but who has not attained the age of 75 years; and (b) to have neither– (i) within the preceding 3 years attended either a consultation with, or a clinic provided by, any doctor, nor (ii) within the preceding 12 months been offered a consultation pursuant to this sub-paragraph by any doctor, to participate in a consultation at his practice premises 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 a doctor who is a restricted services principal. (3) In the case of any patient who is included on the doctor’s list on 1st April 1990, the first invitation to participate in a consultation pursuant to sub-paragraph (1) shall be made no later than 1st April 1991. (4) When inviting a patient to participate in a consultation pursuant to sub-paragraph (1) a doctor shall comply with the requirements of paragraph 13B(3). (5) Where a patient agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation– (a) where appropriate, 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 diseases, 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 height, weight and blood pressure, and (ii) the taking of a urine sample and its analysis to identify the presence of albumin and glucose; (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; and (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. (13D) (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 patient 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) An invitation and an offer pursuant to sub-paragraph (1) shall be made by a doctor– (a) in the case of a patient who is over the age of 75 years and is on the doctor’s list on 31st March 1990, by no later than 1st April 1991; (b) in the case of a patient who attains the age of 75 years on or after 1st April 1990, within 12 months of his 75th birthday; (c) in the case of a patient who– (i) is accepted by the doctor pursuant to paragraph 6, or assigned to him pursuant to regulation 16, after 1st April 1990, and (ii) who has attained the age of 75 years when he is so accepted or assigned, 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 appears to him to be affecting the patient’s general health, including where appropriate the patient's– (a) sensory functions; (b) mobility; (c) mental condition; (d) physical condition including continence; (e) social environment; (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 13B(3) as if that sub-paragraph referred to an offer as well as 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.

6

For paragraph 15 (absences) there shall be substituted the following paragraph:–

(15) (1) Subject to paragraph (2), a doctor is responsible for ensuring the provision to his patients of the services referred to in paragraph 13 throughout each day during which his name is included in the Committee’s medical list. (2) A doctor who was, pursuant to the provisions of this sub-paragraph as in force immediately prior to 1st April 1990, relieved by the Committee of such responsibility in respect of his patients during times approved by the Committee may continue to enjoy such relief for so long as his name is included in the medical list.

7

In paragraph 16–

• (a) in sub-paragraph (1) for “(2) and (3)” there shall be substituted “(2), (3), (4) and (5)”;

• (b) in sub-paragraph (2) after the words “maternity medical services” there shall be inserted the words “, child health surveillance services or minor surgery services”;

• (c) after sub-paragraph (3) there shall be inserted the following paragraphs:–

(4) In the case of child health surveillance services, a doctor who has, pursuant to paragraph 9A(a), undertaken to provide such services may employ for the purposes of providing such services a deputy or an assistant whose name is included in a child health surveillance list or, with the consent of the Committee, some other deputy or assistant. (5) In the case of minor surgery services, a doctor who has, pursuant to paragraph 9A(b), undertaken to provide such services may employ a deputy or an assistant whose name is included in a minor surgery list to conduct a procedure described in Schedule 1B to these Regulations.

8

After paragraph 24 there shall be inserted the following paragraph:—

(24A) (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) 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 (c) any guidance issued by the Committee pursuant to regulation 33B. (3) A doctor shall afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee’s competence.

9

For paragraph 25 there shall be substituted the following paragraphs:—