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

(25) (1) Any doctor whose name is included in a medical list shall, after 31st March 1990– (a) normally be available at such times and places as shall have been approved by the Committee or, on appeal, by the Secretary of State in his case, in accordance with the requirements of the following provisions of this paragraph, following an application by the doctor; and (b) inform his patients about his availability in such manner as the Committee may require in accordance with sub-paragraph (14). (2) Subject to sub-paragraphs (3) and (4), a Committee shall not approve any application submitted by a doctor in relation to the times at which he is to be available unless it is satisfied that the times proposed are such that– (a) the doctor will normally be available– (i) in 42 weeks in any period of twelve months, (ii) during not less than 26 hours in any such week, and (iii) on 5 days in any such week; and (b) the hours for which the doctor will normally be available in any week are to be allocated between the days on which he will normally be available in that week in such a manner as is likely to be convenient to his patients. (3) On any application made pursuant to sub-paragraph (1) by a doctor who is a restricted services principal or a restricted list principal– (a) sub-paragraph (2) shall not apply; and (b) the Committee shall approve the application provided that it is satisfied that the times at which the doctor proposes normally to be available are likely to be convenient to his patients. (4) The Committee may, in relation to the application of any doctor– (a) who seeks normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a), excuse the doctor from the requirement of head (a)(iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 25A; (b) who seeks normally to be available for either– (i) less than 26 hours but not less than 19 hours, or (ii) less than 19 hours but not less than 13 hours, in any week referred to in sub-paragraph (2)(a), excuse the doctor from the requirements of head (a)(ii) and (iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 25B; (c) to whom either paragraph 25C or 25D applies, excuse the doctor from the requirement of head (a)(ii) and (iii) of sub-paragraph (2) to the extent allowed by paragraph 25C or, as the case may be, paragraph 25D. (5) In this paragraph and in paragraphs 25A to 25D, “available” means, in relation to a doctor, available to provide general medical services to his patients, and for the purposes of calculating the times at which a doctor is to be 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; and “availability” shall be construed accordingly. (6) An application by a doctor in relation to any place at which he is to be available shall not be approved by the Committee unless it is satisfied that– (a) the place at which the doctor proposes to be available is likely to be convenient to his patients; (b) the location of that place is in accordance with any condition imposed in his case pursuant to section 33 of the National Health Service Act 1977[^f00010] (distribution of general medical services). (7) An application for approval pursuant to sub-paragraph (1) shall be made in writing to the Committee and shall– (a) include the information specified in Part I of Schedule 1C to these Regulations; and (b) where appropriate, also include– (i) in the case of a doctor to whom sub-paragraph (3) applies, the additional information specified in Part II of that Schedule, (ii) in the case of a doctor to whom sub-paragraph (4)(a) applies, the additional information specified in Part III of that Schedule, (iii) in the case of a doctor to whom sub-paragraph (4)(b) applies, the additional information specified in Part IV of that Schedule, (iv) in the case of a doctor to whom paragraph 25C(1) applies, the additional information specified in Part V of that Schedule, and (v) in the case of a doctor to whom paragraph 25D(1) applies, the additional information specified in Part VI of that Schedule; (c) be made– (i) in the case of a doctor whose name is included in the medical list on 1st January 1990, by 1st February 1990, (ii) in the case of a doctor who is notified after 1st January 1990 that his name is included in a medical list, within 28 days of his receiving such notification. (8) The Committee shall determine an application within 28 days of receiving it. (9) In determining any application, the Committee shall either– (a) grant approval; (b) grant approval subject to such conditions as the Committee 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 (c) refuse approval. (10) The Committee 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 (11). (11) A doctor may within 28 days of receiving a notification pursuant to sub-paragraph (10) appeal in writing to the Secretary of State against any refusal of approval or against any condition imposed pursuant to sub-paragraph (9). (12) The Secretary of State may when determining an appeal either confirm the determination of the Committee or substitute his own determination for that of the Committee. (13) The Secretary of State shall notify the doctor in writing of his determination and shall in every case include with the notification a written statement of the reasons for the determination. (14) The Committee may, as it considers appropriate, require a doctor to inform his patients, by displaying a notice at his practice premises or sending notices to them, about the times and places at which he is available. (25A) (1) Subject to sub-paragraph (3), where the Committee 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 25(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; (c) the improvement of the quality of such care or treatment; or (d) the administration of services under Part I of the National Health Service Act 1977 or of arrangements pursuant to section 29 of that Act for the provision of general medical services, and in determining whether any activity is a health-related activity, the Committee shall have regard to the illustrative list in Part VII of Schedule 1C to these Regulations. (3) The Committee shall not give its approval in accordance with sub-paragraph (1) if, in its opinion– (a) the effectiveness of the doctor’s services to his patients is likely to be significantly reduced; or (b) his patients are likely to suffer significant inconvenience, by reason of the doctor’s having been relieved from the requirements of paragraph 25(2)(a)(iii). (25B) (1) Subject to sub-paragraph (2), the Committee may, in the case of a doctor– (a) who practises in partnership with another doctor– (i) whose name is included in the medical list, and (ii) who is normally available for not less than 26 hours in each of the weeks referred to in paragraph 25(2)(a); and (b) who seeks normally to be available for either– (i) less than 26 hours but not less than 19 hours, or (ii) less than 19 hours but not less than 13 hours, determine the application as if for the reference to 26 hours in paragraph 25(2)(a)(ii) there were substituted a reference to 19 hours or 13 hours, as the case may be. (2) Any approval of an application which has been determined in accordance with sub-paragraph (1) 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 head (a) of that sub-paragraph. (25C) (1) Subject to sub-paragraph (2), where a doctor applies for the approval of the Committee pursuant to paragraph 25(1) jointly with another doctor– (a) with whom he practises in partnership; (b) whose name is included in the medical list; and (c) with whom he proposes to operate an arrangement whereby– (i) each doctor will normally be available for less than 26 hours in any week referred to in paragraph 25(2)(a), but (ii) the hours for which both doctors will normally be available will in aggregate be not less than 26 hours in any such week, the Committee may approve the application, notwithstanding that neither doctor can himself satisfy the requirement specified in paragraph 25(2)(a)(ii). (2) Any approval of an application to which sub-paragraph (1) applies 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 arrangement referred to in head (c) of that sub-paragraph comes to an end. (25D) (1) Subject to sub-paragraph (3), where a doctor– (a) does not practise in partnership with any other doctor; (b) has no more than 599 patients on his list on 31st January 1990; and (c) during the period of 12 months immediately preceding that date– (i) was normally available for an average of less than 20 hours each week, and (ii) in consequence, had his remuneration abated by the Committee, in accordance with the Statement published pursuant to regulation 24(1); (d) seeks normally to be available, in each week referred to in regulation 25(2)(a), for not less than the number of hours for which he had, on average, been available in each week during the period mentioned in head (c) above, the Committee may approve the application notwithstanding that the doctor will not normally be available in accordance with paragraph 25(2)(a)(ii). (2) When calculating the average hours for the purposes of sub-paragraph (1)(c)(i), account shall be taken of the aggregate number of hours for which the doctor was normally available to patients in the localities of all Committees on whose medical lists his name was included. (3) Any approval by the Committee in relation to a doctor to whom sub-paragraph (1) applies shall be subject to the condition that it shall lapse on 1st April 1991.

10

After paragraph 29 (practice area) there shall be inserted the following paragraph:–

(29A) Where a doctor whose name is included in the medical list changes his place of residence he shall notify the Committee in writing of the change not later than 28 days after such change.

11

In paragraph 32 (acceptance of fees) after sub-paragraph (1) there shall be added the following sub-paragraph:–

(m) where the person is not one to whom any of paragraphs (a), (b) or (c) of section 38(1) of the National Health Service Act 1977[^f00011] applies (including by reason of regulations under section 38(6) of that Act), for testing the sight of that person.

12

After paragraph 38A there shall be inserted the following paragraph–

(38B) (1) Subject to sub-paragraph (2), a doctor whose name is included in the medical list shall from 1st April 1990 compile in relation to his practice a document (in this paragraph called a “practice leaflet”) which shall include the information specified in Schedule 1D to these Regulations. (2) Sub-paragraph (1) shall, in relation to a doctor referred to in regulation 4(2)(e), apply only to the extent that the Committee sees fit. (3) A doctor shall review his practice leaflet at least once in every period of 12 months, and shall make any amendments necessary to maintain its accuracy. (4) A doctor shall from 1st April 1990, or from such later date (being not later than 1st July 1990) as the Committee may allow, make available a copy of the most recent edition of his practice leaflet to the Committee, to each patient on his list and to any other person who, in the doctor’s opinion, reasonably requires one. (5) A doctor who practises in partnership with other doctors whose names are included in the medical list shall satisfy the requirements of this paragraph if he makes available a practice leaflet, compiled and, where appropriate, revised in accordance with sub-paragraphs (1) and (3) which relates to the partnership as a whole; and in such a case a doctor may, if he so wishes, also produce a practice leaflet relating to his own activities.

13

After paragraph 39 (reports to the medical officer, etc.) there shall be inserted the following paragraph:–

(39A) (1) A doctor whose name is included in the medical list shall, subject to sub-paragraphs (2) and (3) below, sufficiently answer any inquiries, whether oral or in writing, from the Committee concerning– (a) any prescription form issued by the doctor under these terms of service; (b) the considerations by reference to which the doctor issues such forms under these terms of service; (c) the referral by the doctor under these terms of service of any patient to any other services provided under the National Health Service Act 1977; and (d) the considerations by reference to which the doctor refers patients to any such services. (2) An inquiry referred to in sub-paragraph (1) may be made only for the purpose either of obtaining information to assist the Committee to discharge its functions or of assisting the doctor in the discharge of his obligations under these terms of servic (3) A doctor shall not be obliged to answer any inquiry referred to in sub-paragraph (1) unless it is made by a doctor appointed under regulation 33A who produces on request written evidence that he is authorized by the Committee to make such an inquiry on behalf of the Committee.

14

After paragraph 43 there shall be inserted the following paragraph:–

(43A) (1) A doctor whose name is included in the medical list, shall provide annually to the Committee a report, in accordance with this paragraph, relating to the provision by him of personal medical services (in this paragraph called an “annual report”). (2) An annual report shall contain the information specified in Schedule 1E to these Regulations. (3) Each annual report shall be compiled in respect of the period of 12 months ending on the 31st March of the year in which it is provided and shall be sent to the Committee by 30th June of that year. (4) The first annual report shall be sent to the Committee by 30th June 1991 and shall be compiled in respect of the period of 12 months ending on 31st March 1991. (5) In the case of a doctor who practises in partnership with other doctors whose names are included in the medical list, the information referred to in sub-paragraph (2) may alternatively be provided in the form of an annual report in respect of the partnership as a whole instead of by each doctor in the partnership individually and in such a case a doctor may, if he so wishes, also provide his own annual report. (6) Where a Committee requires that the information referred to in sub-paragraph (2) be provided on a form supplied by the Committee, the doctor shall use that form. (7) A Committee shall not disclose any annual report to any person, unless otherwise lawfully empowered to do so.

SCHEDULE 2

PART I — (new part ii to be substituted in schedule 1 to the principal regulations)

PART II — (new part iii to be substituted in schedule 1 to the principal regulations)

SCHEDULE 3 — (NEW PARTS IV AND V TO BE ADDED TO SCHEDULE 1 TO THE PRINCIPAL REGULATIONS)

SCHEDULE 4 — (NEW SCHEDULE 1A TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

SCHEDULE 5 — (NEW SCHEDULE 1B TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

SCHEDULE 6 — (NEW SCHEDULE 1C TO BE INSERTED INTO THE PRINCIPAL REGULATIONS)

SCHEDULE 7 — (NEW SCHEDULE 1D TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

SCHEDULE 8 — (NEW SCHEDULE 1E TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

Signed

Kenneth Clarke — Secretary of State for Health — 15th October 1989

Explanatory note

(This note is not part of the Regulations)

These Regulations further amend the National Health Service (General Medical and Pharmaceutical Services) Regulations 1974 (“the principal Regulations”) which regulate the terms on which general medical and pharmaceutical services are provided under the National Health Service Act 1977 (“the 1977 Act”)

Regulation 3 of the principal Regulations is amended to include child health surveillance services (set out in a new Schedule 1A) and minor surgery services (set out in a new Schedule 1B) among the services provided by medical practioners (“doctors”) in pursuance of arrangements made by a Family Practitioner Committee (“the Committee”) (regulation 3), and new regulations 3A and 3B are inserted to make provision for each Committee to compile and maintain lists of the doctors providing child health surveillance services and minor surgery services in its locality (regulation 4). New Parts IV and V are inserted into Schedule 1 to the principal Regulations (by Schedule 3 to these Regulations) to specify the information to be provided by a doctor applying for the inclusion of his name in, respectively, the child health surveillance list or the minor surgery list.

Amendments are made to require a Committee to record additional information on the list (“the medical list”) it maintains of doctors providing general medical services (regulation 5), and regarding the circumstances in which a doctor’s name may be removed from a medical list (regulation 6). A new regulation 5A is inserted in the principal Regulations to require each Committee to compile and maintain a Local Directory of Family Doctors (“the Local Directory”) in relation to those doctors whose names are included in its medical list, and to oblige doctors to supply certain information to the Committee for the purpose of the Local Directory. A new regulation 5B is also inserted to make provision for the removal of a doctor’s name from any medical list when he attains the age of 70 (regulation 7). Further amendments in connection with the medical list and the Local Directory are made, respectively, by regulations 8 and 9. The forms which must be used by doctors when applying to have their names included in a medical list or to succeed to a practice declared vacant are replaced by a specified list of particulars to be included in an application (Schedule 2 to these Regulations).

Regulation 11 makes provision for a patient’s application to a doctor for the provision of child health surveillance services or minor surgery services and consequential amendments are made to govern the provision of such services, in circumstances where, respectively, a patient is assigned by a Committee to a doctor’s list or where a doctor is providing temporary medical services to a patient (regulations 12 and 15). Regulations 14 and 16 of these Regulations simplify the procedure whereby a patient may change the doctor who is providing, respectively, any general medical services or only maternity medical services. Regulation 17 of these Regulations amends the provision for the remuneration of doctors providing general medical services, and amendments made by regulation 19 provide for the publication by a Committee of its Local Directory and of doctors' practice leaflets. Transitional provision is made (in regulation 24) in respect of any doctor whose claim for fees or allowances earned before the date from which the amendments relating to doctor’s remuneration come into force is not determined until after that date.

Schedule 1 to these Regulations amends the “terms of service” under which doctors provide general medical services to their patients. Paragraph 3 of those terms of service is amended to make provision for the standard of skill, knowledge and care to be expected from doctors providing child health surveillance services and minor surgery services, and an amendment is made to the definition of a doctor’s patients in paragraph 4 to include those persons to whom he provides such services. New paragraphs 9A, 9B, 9C and 12A of the terms of service and new Schedules 1A and 1B to the principal Regulations are inserted to make detailed provision for the nature and application of child health surveillance services and minor surgery services, and new paragraphs 13 to 13D of the terms of service are inserted to provide, generally and in relation to particular classes of patient, for the nature of the services a doctor must provide. In particular, a doctor is, in addition to his general obligations, required to offer a consultation to newly registered patients (new paragraph 13B), to patients whom he has not seen within the preceding 3 years (new paragraph 13C) and to patients who have attained the age of 75 (new paragraph 13D).

Paragraph 15 of the terms of service is amended to provide that a doctor is at all times responsible for the provision of general medical services to his patients, while enabling those doctors who have before 1st April 1990 been relieved by the Committee of such responsibility at certain times to continue to enjoy such relief after that date. An amendment is made in paragraph 16 in connection with the employment of assistants and deputies by doctors when providing child health surveillance services or minor surgery services. A new paragraph 24A is inserted in the terms of service to require a doctor to satisfy himself as to the suitability and competence of prospective employees, having regard in particular to any guidance to doctors by the Committee under the new regulation 33B in the principal Regulations (inserted by regulation 20).

A new paragraph 25 is substituted in the terms of service to require a doctor to obtain the approval of the Committee for the times and places at which he proposes to be available for consultation by his patients, and new paragraphs 25A, 25B, 25C and 25D are also inserted to make provision for the circumstances in which, and the extent to which, a Committee may approve a proposal by a doctor to be available for fewer hours, or on fewer days, in each week than are specified in the new paragraph 25. A new Schedule 1C is inserted in the principal Regulations to specify the information to be included in applications by doctors for the purposes of paragraph 25.

A new paragraph 29A is inserted in the terms of service requiring a doctor to notify the Committee of any change in his place of residence, and paragraph 42 is amended to enable an ophthalmic doctor to demand or accept a fee or remuneration for testing the sight of a patient. A new paragraph 38B is inserted to oblige a doctor to produce annually, and to make available to the Committee, to his patients and to certain other persons, a practice leaflet which must include certain information (specified in a new Schedule 1D) about the personal medical services he provides. New paragraph 39A requires a doctor to answer enquiries made by a Committee’s medical adviser (appointed in accordance with new regulation 33A) in connection with his prescribing of drugs and appliances for his patients and his referral of them to other services provided under the 1977 Act. A new paragraph 43A also obliges a doctor to provide annually to the Committee a report which must include certain information (specified in a new Schedule 1E) about his practice.

Regulation 18 of these Regulations amends regulation 25(3) of the principal Regulations which defines the supplemental services which can be provided as part of pharmaceutical services. Regulation 23 removes one substance from, and includes other drugs and substances in, Schedule 3A to the principal Regulations, which contains a list of drugs and other substances which may not be prescribed for supply, and which may not be dispensed, in the course of pharmaceutical services provided under the 1977 Act.

These Regulations also effect consequential amendments in the principal Regulations arising out of and in connection with the changes mentioned above.

Footnotes

[^f00001]: 1977 c. 49; section 15(1) was amended by the Health Services Act 1980 (c. 53) (“the 1980 Act”), Schedule 1, paragraphs 35 and 90, and by the Health and Social Security Act 1984 (c. 48), section 5(2) and Schedule 8; section 29 was amended by the 1980 Act, section 7 and Schedule 1, paragraph 42, and by the Health and Social Services and Social Security Adjudications Act 1983 (c. 41) (“the 1983 Act”), Schedule 6, paragraph 2; section 41 was amended by the 1980 Act, section 20(1) and Schedule 1, paragraph 53 and Schedule 7; section 42 was substituted by section 3(1) of the National Health Service (Amendment) Act 1986 (c. 66) and amended by S.I. 1987/2202, article 4; sections 29 and 41 were each modified by S.I. 1985/39; see section 128(1) of the National Health Service Act 1977 for the definitions of “prescribed” and “regulations”; paragraph 10(1) of Schedule 5 was amended by the 1983 Act, Schedule 6, paragraph 3.

[^f00002]: 1988 c. 49;see S.I. 1989/1896.

[^f00003]: 1971 c. 62.

[^f00004]: S.I. 1974/160; the relevant amending instruments are S.I. 1975/719, 1982/1283, 1985/39, 290, 540, 803, 955, 1053, 1712, 1986/381, 916, 1486, 1987/5, 401, 1425, 1988/1106, 2297 and 1989/1360.

[^f00005]: 1977 c. 49; section 46 was amended by the Health and Social Security Act 1984 (c. 48), Schedule 8, and modified by S.I. 1985/39, article 7(16).

[^f00006]: 1983 c. 54.

[^f00007]: 1984 c. 23.

[^f00008]: S.I. 1989/419.

[^f00009]: 1977 c. 49.

[^f00010]: 1977 c. 49; section 33 was amended by S.I. 1981/432, article 3(2), and by the Health and Medicines Act 1988 (c. 49), Schedule 2, paragraph 3, and was modified by S.I. 1985/39, article 7(7).

[^f00011]: 1977 c. 49; section 38 was amended by the Health and Social Security Act 1984 (c. 48), section 1(3), by S.I. 1985/39, article 7(11), and by the Health and Medicines Act 1988 (c. 49), section 13(1).

[^f00012]: 1983 c. 54.

[^f00013]: S.I. 1979/1644.