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The National Health Service (Personal Medical Services Agreements) Regulations 2015

Type Statutory-Instrument

Publication 2015-11-06

Last updated 2026-07-10

State In force

Department Statute Law Database

Source legislation.gov.uk

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(2) The contractor must comply with the requirement in sub-paragraph (1) by screening the patient using either one of the two shortened versions of the World Health Organisation Alcohol Use Disorders Identification (“AUDIT”) questionnaires which are known as—

(a) FAST (which has four questions); or

(b) AUDIT-C (which has three questions).

(3) Where, under sub-paragraph (2), the contractor identifies a patient as positive using either of the shortened versions of the AUDIT questionnaire specified in sub-paragraph (2), the remaining questions of the full ten question AUDIT questionnaire must be used by the contractor to determine increasing risk, higher risk or likely dependent drinking.

(4) Where a patient is identified as drinking at increasing or higher risk levels, the contractor must—

(a) offer the patient appropriate advice and lifestyle counselling;

(b) respond to any other need identified in the patient which relates to the patient's levels of drinking, including by providing any additional support or treatment required for people with mental health issues; and

(c) in any case where the patient is identified as a dependent drinker, offer the patient a referral to such specialist services as are considered clinically appropriate to meet the needs of the patient.

(5) Where a patient is identified as drinking at increasing or higher risk levels or as a dependent drinker, the contractor must ensure that the patient is—

(a) assessed for anxiety and depression;

(b) offered screening for anxiety or depression; and

(c) where anxiety or depression is diagnosed, provided with any treatment and support which may be required under the agreement, including a referral for specialist mental health treatment.

(6) The contractor must make relevant entries, including the results of the completed questionnaire referred to in sub-paragraph (2), in the patient's record that the contractor is required to keep under regulation 60.

Patients living with frailty

14A

(1) A contractor must take steps each year to identify any registered patient aged 65 years and over who is living with moderate to severe frailty.

(2) The contractor must comply with the requirement in sub-paragraph (1) by using the Electronic Frailty Index or any other appropriate assessment tool.

(3) Where the contractor identifies a patient aged 65 years or over who is living with severe frailty, the contractor must—

(a) undertake a clinical review in respect of the patient which includes—

(i) an annual review of the patient’s medication, and

(ii) where appropriate, a discussion with the patient about whether the patient has fallen in the last 12 months;

(b) provide the patient with any other clinically appropriate interventions; and

(c) where the patient does not have an enriched Summary Care Record, advise the patient about the benefits of having an enriched Summary Care Record and activate that record at the patient’s request.

(4) A contractor must, using codes agreed by NHS England for this purpose, record in the patient’s Summary Care Record any appropriate information relating to clinical interventions provided to a patient under this paragraph.

Accountable GP

15

(1) A contractor must ensure that for each of its registered patients (including those patients under the age of 16) there is assigned an accountable general medical practitioner (“accountable GP”).

(2) The accountable GP must take lead responsibility for ensuring that any services which the contractor is required to provide under the agreement are, to the extent that their provision is considered necessary to meet the needs of the patient, coordinated and delivered to the patient.

(3) The contractor must—

(a) inform the patient, as soon as is reasonably practicable and in such manner as is considered appropriate by the contractor's practice, of the assignment to the patient of an accountable GP and must state the name and contact details of the accountable GP and the role and responsibilities of the accountable GP in respect of the patient;

(b) inform the patient as soon as any circumstances arise in which the accountable GP is not able, for any significant period, to carry out the duties of an accountable GP in respect of the patient; and

(c) where the contractor's practice considers it to be necessary, assign a replacement accountable GP to the patient and inform the patient accordingly.

(4) The contractor must comply with the requirement in sub-paragraph (3)(a) in the case of any person who is accepted by the contractor as a registered patient on or after the date on which these Regulations come into force, within 21 days from the date on which that person was so accepted.

(5) The requirement in this paragraph does not apply to—

(a) any patient of the contractor who is aged 75 or over, or who attains the age of 75, on or after the date on which these Regulations come into force; or

(b) any other patient of the contractor if the contractor has been informed that the patient does not wish to have an accountable GP.

(6) Where, under sub-paragraph (3)(a), the contractor informs a patient of the assignment to them of an accountable GP, the patient may express a preference as to which general medical practitioner within the contractor's practice the patient would like to have as the patient's accountable GP and, where such a preference has been expressed, the contractor must make reasonable efforts to accommodate the request.

(7) Where, under sub-paragraph (5)(b), the contractor has been informed by or in relation to a patient that the patient does not wish to have an accountable GP, the contractor must record that fact in the patient's record that the contractor is required to keep under regulation 60.

(8) The contractor must ... include information about the requirement to assign an accountable GP to each of its new and existing registered patients—

(a) on the contractor's practice website or online practice profile; and

(b) in the contractor's practice leaflet.

(9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patients aged 75 years and over: accountable GP

16

(1) A contractor must ensure that for each of its registered patients aged 75 and over there is assigned an accountable general medical practitioner (“accountable GP”).

(2) The accountable GP must—

(a) take lead responsibility for ensuring that any services which the contractor is required to provide under the agreement are, to the extent that their provision is considered necessary to meet the needs of the patient, delivered to the patient;

(b) take all reasonable steps to recognise and appropriately respond to the physical and psychological needs of the patient in a timely manner;

(c) ensure that the patient receives a health check if, and within a reasonable period after, one has been requested; and

(d) work co-operatively with other health and social care professionals who may become involved in the care and treatment of the patient to ensure the delivery of a multi-disciplinary care package designed to meet the needs of the patient.

(3) The contractor must—

(a) inform the patient, in such manner as is considered appropriate by the contractor's practice, of the assignment to the patient of an accountable GP;

(b) provide the patient with the name and contact details of the accountable GP and information regarding the role and responsibilities of the accountable GP in respect of the patient;

(c) inform the patient as soon as any circumstances arise in which the accountable GP is not able, for any significant period, to carry out the duties of an accountable GP in respect of the patient; and

(d) where the contractor's practice considers it to be necessary, assign a replacement accountable GP to the patient and inform the patient accordingly.

(4) The contractor must comply with the requirement in sub-paragraph (3)(a)—

(a) in the case of any person aged 75 or over who is accepted by the contractor as a registered patient on or after the date on which these Regulations come into force, before the end of the period of 21 days beginning with the date on which that person is so accepted; or

(b) in the case of a person who is included in the contractor's list of patients immediately before the date on which these Regulations come into force and who attains the age of 75 or over on or after that date, before the end of the period of 21 days after the date on which that person attained that age.

(5) In this paragraph, “health check” means a consultation undertaken by the contractor in the course of which the contractor must make such inquiries and undertake such examinations of the patient as appear to it to be appropriate in all the circumstances.

NHS e-Referral Service (e-RS)

16A

(1) Except in the case of a contractor to which sub-paragraph (2) or (3) applies, a contractor must require the use in its practice ... of the system for electronic referrals known as the NHS e-Referral Service (“e-RS”) in respect of each referral of any of its registered patients to a first consultant-led out-patient appointment for medical services under the Act in respect of which the facility to use e-RS is available.

(2) This sub-paragraph applies to a contractor which does not yet have e-RS in place for use in the contractor’s practice ....

(3) This sub-paragraph applies to a contractor which—

(a) is experiencing technical or other practical difficulties which are preventing the use, or effective use, of e-RS in its practice ...; and

(b) has notified NHS England that this is the case.

(4) A contractor to which sub-paragraph (2) applies must require the use in its practice ... of alternative means of referring its registered patients to a first consultant-led out-patient appointment for medical services under the Act until such time as the contractor has e-RS in place for use in its practice ....

(5) A contractor to which sub-paragraph (3) applies—

(a) must ensure that a plan is agreed between the contractor’s practice and NHS England for resolving the technical or other practical difficulties which are preventing the use, or effective use, of e-RS in the contractor’s practice ...; and

(b) must require the use in its practice ... of alternative means of referring its registered patients to a first consultant-led out-patient appointment for medical services under the Act until such time as those technical or other practical difficulties have been resolved to the satisfaction of NHS England.

Direct booking by NHS 111 or via a connected service

16B

(1) A contractor must ensure that as a minimum the following number of appointments during core hours for its registered patients are made available per day for direct booking by or via a service (“a connected service”) approved by NHS England that is or may be accessed via NHS 111—

(a) one, where a contractor has 3,000 registered patients or fewer; or

(b) one for each whole 3,000 registered patients, where a contractor has more than 3,000 registered patients.

(2) The requirements in sub-paragraphs (1) and (3) do not apply where—

(a) NHS England and the contractor have agreed to suspend the requirements for operational reasons; or

(b) the contractor does not have access to computer systems and software which would enable it to offer the service described in sub-paragraph (1).

(3) A contractor must—

(a) configure its computerised systems to allow direct booking by NHS 111 or via a connected service;

(b) monitor its booking system for appointments booked by NHS 111 or via a connected service;

(c) assess the Post Event Message received from NHS 111 or via a connected service in order to decide whether an alternative to the booked appointment should be arranged, such as a telephone call to the patient or an appointment with another healthcare professional and where appropriate, make those arrangements; and

(d) co-operate with NHS England in its oversight of direct booking by NHS 111 or via a connected service by providing any information relating to direct booking by NHS 111 or via a connected service which is reasonably required by NHS England.

(4) In this paragraph, “Post Event Message” means the electronic message which is sent to a contractor at the end of a telephone call to NHS 111 or to a connected service.

(5) In order to assist in the management of a serious or potentially serious risk to human health arising as a consequence of a disease being, or in anticipation of a disease being imminently—

(a) pandemic; and

(b) a serious risk or potentially a serious risk to human health,

NHS England may with the agreement of the Secretary of State make an announcement to the effect that the minimum numbers of appointments mentioned in paragraph (1) are modified in the circumstances specified (which may limit the area to which the modification relates), and for the duration of the period specified, in the announcement, and where NHS England does so, the minimum numbers are as so modified.

Referral pathways

16C

(1) NHS England may notify the contractor of referral pathways that apply to the referral of patients for other services under the Act.

(2) The contractor must, where clinically appropriate, comply with any relevant referral pathways notified under paragraph (1), prior to referring a patient for services under the Act.

(3) In this paragraph—

“Advice and Guidance” means arrangements established by NHS England to enable contractors to obtain consultant-led clinical advice about the management of a patient for the purpose of informing clinical decision making in relation to a referral;

“referral pathways” means arrangements, such as Advice and Guidance, determined by NHS England as applying to the referral of a patient for a service under the Act, including any locally determined arrangements that apply in relation to the contractor’s practice area.

Directory of Services

16D

(1) The contractor must record in the Directory of Services an electronic mail address nominated for the purpose of communicating clinical information relating to the contractor's patients with health service providers.

(2) The contractor must monitor the electronic mail address nominated under paragraph (1) at least once per day during core hours.

(3) In paragraph (1), “Directory of Services” means the national directory of services provided as part of the health service in England, managed by NHS England.

Application for inclusion in a list of patients

17

(1) Subject to sub-paragraph (1C), the contractor may, if the contractor's list of patients is open, accept an application for inclusion in that list made by or on behalf of any person (“the applicant”) whether or not that person is resident in the contractor's practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.

(1A) NHS England may, following consultation with the Local Medical Committee (if any) for the area in which the contractor provides services under the contract, determine that in certain circumstances NHS England’s approval is required before a contractor accepts an application for inclusion in its list of patients in respect of a patient who resides outside the contractor’s practice area.

(1B) Where NHS England has made a determination in accordance with sub-paragraph (1A) it must set out the circumstances in which its approval is required in a notice to the contractor.

(1C) Where NHS England has made a determination in accordance with sub-paragraph (1A), a contractor may only accept an application for inclusion in its list of patients in respect of a person who resides outside the contractor’s practice area in the circumstances set out in a notice given under sub-paragraph (1B) with NHS England’s approval.

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

(3) Subject to sub-paragraph (4), the contractor may only accept an application for inclusion in that list if it is—

(a) an application on a form specified to the contractor by NHS England; or

(b) an application through the online registration service supplied to the contractor by NHS England.

(3A) The contractor must make available both application methods referred to in sub-paragraph (3).

(4) An application may be made—

(a) where the patient is a child, on behalf of the patient by—

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

(ii) a person duly authorised by a local authority to whose care the child has been committed under the Children Act 1989 , or

(iii) a person duly authorised by a voluntary organisation by which the child is being accommodated under the provisions of the Children Act 1989; or

(b) where the patient is an adult who lacks the capacity to make such an application, or to authorise such an application to be made on their behalf, by—

(i) a relative of that person,

(ii) the primary carer of that person,

(iii) a donee of a lasting power of attorney granted by that person, or

(iv) a deputy appointed for that person by the court under the Mental Capacity Act 2005 .

(4A) Where the contractor receives an application by the method referred to in sub-paragraph (3)(a), they must submit the information provided in the application via the online registration service referred to in sub-paragraph (3)(b), except where the contractor’s computerised clinical system does not facilitate interconnectivity with the online registration service supplied by NHS England.

(5) Where a contractor accepts an application for inclusion in the contractor's list of patients, the contractor must give notice in writing to NHS England of that acceptance as soon as possible.

(6) NHS England must, on receipt of a notice given under sub-paragraph (5)—

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

(b) give notice in writing to the applicant (or, in the case of a child or an adult who lacks capacity, to the person making the application on the applicant's behalf) of that acceptance.

(7) This paragraph is subject to Part 2A.

Inclusion in list of patients: armed forces personnel

18

(1) The contractor may, if the contractor's list of patients is open, include a person to whom sub-paragraph (2) applies in its list of patients for a period of up to two years and paragraph 28(1)(b) does not apply in respect of any person included in the contractor's by virtue of this paragraph.

(2) This sub-paragraph applies to a person who is—

(a) a serving member of the armed forces of the Crown who has received written authorisation from Defence Medical Services to receive primary medical services from the contractor's practice; and

(b) living or working within the contractor's practice area during the period in respect of which that written authorisation is given.

(3) Where the contractor has accepted a person to whom sub-paragraph (2) applies onto its list of patients, the contractor must—

(a) obtain a copy of the patient's medical record or a summary of that record from Defence Medical Services; and

(b) provide regular updates to Defence Medical Services at such intervals as are agreed with Defence Medical Services about any care and treatment which the contractor has provided to the patient.

(4) At the end of the period of two years, or on such earlier date as the contractor's responsibility for the patient comes to an end, the contractor must—

(a) notify Defence Medical Services in writing that its responsibility for that person has come to an end; and

(b) update the patient's medical record, or summary of that record, and return it to Defence Medical Services.

Inclusion in list of patients: detained persons

18A

(1) A contractor must, if the contractor’s list of patients is open, include a person to whom sub-paragraph (2) applies (a “detained person”) in that list and paragraph 28(1)(b) does not apply in respect of a detained person who is included in the contractor’s list of patients by virtue of this paragraph.

(2) This sub-paragraph applies to a person who—

(a) is serving a term of imprisonment of more than two years, or more than one term of imprisonment totalling, in the aggregate, more than two years;

(b) is not registered as a patient with a provider of primary medical services; and

(c) makes an application under this paragraph in accordance with sub-paragraph (3) to be included in the contractor’s list of patients by virtue of sub-paragraph (1) or (6) before the scheduled release date.

(3) An application under sub-paragraph (2)(c) may be made during the period commencing one month prior to the scheduled release date and ending 24 hours prior to that date.

(4) Subject to sub-paragraphs (5) and (6), a contractor may only refuse an application under sub-paragraph (2)(c) if the contractor has reasonable grounds for doing so which do not relate to the applicant’s age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class.

(5) The reasonable grounds referred to in sub-paragraph (4) may include the ground that the applicant will not, on or after the scheduled release date, live in the contractor’s practice area or does not intend to live in that area.

(6) Where a contractor’s list of patients is closed, the contractor may, by virtue of this sub-paragraph, accept an application under sub-paragraph (2)(c) if the applicant is an immediate family member of a registered patient.

(7) Where a contractor accepts an application from a person under sub-paragraph (2)(c) for inclusion in the contractor’s list of patients, the contractor—

(a) must give notice in writing to the provider of the detained estate healthcare service or to NHS England of that acceptance as soon as possible; and

(b) is not required to provide primary medical services to that person until after the scheduled release date.

(8) NHS England must, on receipt of a notice given under sub-paragraph (7)(a)—

(a) include the applicant in the contractor’s list of patients from the date notified to NHS England by the provider of the detained estate healthcare service; and

(b) give notice in writing to the provider of the detained estate healthcare service of that acceptance.

(9) Where a contractor refuses an application made under sub-paragraph (2)(c), the contractor must give notice in writing of that refusal, and the reasons for it, to the provider of the detained estate healthcare service or to NHS England before the end of the period of 14 days beginning with the date of its decision to refuse.

(10) The contractor must—

(a) keep a written record of—

(i) the refusal of an application under sub-paragraph (2)(c), and

(ii) the reasons for that refusal; and

(b) make such records available to NHS England on request.

(11) In this paragraph—

(a) “the detained estate healthcare service” means the healthcare service commissioned by NHS England in respect of persons who are detained in prison or in other secure accommodation by virtue of regulations made under section 3B(1)(c) of the Act (Secretary of State’s power to require NHS England to commission services); and

(b) “the scheduled release date” means the date on which the person making an application under sub-paragraph (2)(c) is due to be released from detention in prison.

Temporary residents

19

(1) The contractor may, if the contractor's list of patients is open, accept a person as a temporary resident provided the contractor is satisfied that the person is—

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

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

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

(3) Where a contractor wants to terminate its responsibility for a person accepted by it as a temporary resident before the end of —

(a) the period of three months; or

(b) such shorter period for which the contractor agreed to accept that person as a temporary resident,

the contractor must give notice of that fact to the person either orally or in writing and the contractor's responsibility for that person is to cease seven days after the date on which such notice is given.

(4) Where the contractor's responsibility for a person as a temporary resident comes to an end, the contractor must give notice in writing to NHS England of its acceptance of that person as a temporary resident—

(a) at the end of the period of three months beginning with the date on which the contractor accepted that person as a temporary resident; or

(b) if the contractor's responsibility for that person as a temporary resident came to an end earlier than the end of the three month period referred to in paragraph (a), at the end of that period.

(5) This paragraph is subject to Part 2A.

Refusal of applications for inclusion in list of patients or for acceptance as a temporary resident

20

(1) The contractor may only refuse an application made under paragraph 17 or 19 if the contractor has reasonable grounds for doing so which do not relate to the applicant's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class.

(2) The reasonable grounds referred to in sub-paragraph (1) may, in the case of an application made under paragraph 17, include the ground that the applicant—

(a) does not live in the contractor's practice area; or

(b) lives in the outer boundary area (the area referred to in regulation 13(2)).

(3) Where a contractor refuses an application made under paragraph 17 or 19, the contractor must give notice in writing of that refusal and of the reason for it to the applicant (or, in the case of a child or an adult who lacks capacity, the person making the application on the applicant's behalf) before the end of the period of the period of 14 days beginning with the date of the decision to refuse.

(4) The contractor must—

(a) keep a written record of—

(i) the refusal of any application made under paragraph 17,

(ii) the reasons for that refusal; and

(b) make such records available to NHS England on request.

Patient preference of a practitioner

21

(1) Where the contractor has accepted an application made under paragraph 17, 19, 31D, 31E, 31F or 31G, the contractor must—

(a) give notice in writing to the person (or, in the case of a child or an adult who lacks capacity, to the person who made the application on the applicant's behalf) of that person's right to express a preference to receive services from a particular performer or class of performer either generally or in relation to any particular condition; and

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

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

(a) has reasonable grounds for refusing to provide services to the person who expressed the preference; or

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

Removal from the list at the request of the patient

22

(1) The contractor must give notice in writing to NHS England of a request made by any person who is a registered patient to be removed from the contractor's list of patients.

(2) Where NHS England—

(a) receives a notice given by the contractor under sub-paragraph (1); or

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

NHS England must remove that person from the contractor's list of patients.

(3) The removal of a person from a contractor's list of patients in accordance with this paragraph takes effect on whichever is the earlier of—

(a) the date on which NHS England is given notice of the registration of that person with another provider of essential services (or their equivalent); or

(b) 14 days after the date on which the notice given under sub-paragraph (1) or the request made under sub-paragraph (2) is received by NHS England

(4) NHS England must, as soon as practicable, give notice in writing to—

(a) the person who requested the removal; and

(b) the contractor,

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

(5) In this paragraph, and in paragraphs 23(1)(b) and (9), 24(6) and (7), 25(1), 28(2) and 29(3), a reference to a request received from, or advice, information or notice required to be given to, a person includes a request received from or advice, information or notice required to be given to—

(a) in the case of a child, on behalf of the patient—

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

(ii) a person duly authorised by a local authority to whose care the child has been committed under the Children Act 1989 , or

(iii) a person duly authorised by a voluntary organisation by whom the child is being accommodated under the Children Act 1989; or

(b) in the case of an adult patient who lacks capacity to make the relevant request or receive the relevant advice, information or notice—

(i) a relative of that person,

(ii) the primary carer of that person,

(iii) a donee of a lasting power of attorney granted by that person, or

(iv) a deputy appointed for that person by the court under the provisions of the Mental Capacity Act 2005 .

Removal from the list at the request of the contractor

23

(1) Subject to paragraph 24, where a contractor has reasonable grounds for wanting a person to be removed from its list of patients which do not relate to the person's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class, the contractor must—

(a) give notice in writing to NHS England that it wants to have that person removed; and

(b) subject to paragraph (2), give notice in writing to that person of its specific reasons for requesting the removal of that person.

(2) Where, in the reasonable opinion of the contractor—

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

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

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

(3) Except in the circumstances specified in sub-paragraph (4), a contractor may only request the removal of a person from its list of patients under sub-paragraph (1) if, before the end of the period of 12 months beginning with the date of the contractor's request to NHS England, the contractor has—

(a) warned the person of the risk of being removed from that list; and

(b) explained to that person the reasons for this.

(4) The circumstances specified in this sub-paragraph are that—

(a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

(i) be harmful to the person's physical or mental health, or

(ii) put at risk the safety of any party to the agreement who is an individual, any member of the contractor's staff or any other person; or

(5) The contractor must keep a written record of—

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

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

(6) The contractor must keep a written record of the removal of any person from its list of patients under this paragraph which must include—

(a) the reason given for the removal;

(b) the circumstances of the removal; and

and the contractor must make this record available to NHS England on request.

(7) The removal of a person from the contractor's list of patients in accordance with this paragraph must, subject to sub-paragraph (8), take effect from whichever is the earlier of—

(a) the date on which NHS England is given notice of the registration of that person with another provider of essential services (or their equivalent); or

(b) the eighth day after NHS England receives the notice referred to in sub-paragraph (1)(a).

(8) Where, on the date on which the removal of a person would take effect under sub-paragraph (7), the contractor is treating that person at intervals of less than seven days, the contractor must give notice in writing to NHS England of that fact and the removal is to take effect on whichever is the earlier of—

(a) the eighth day after NHS England is given notice by the contractor that the person no longer needs such treatment; or

(b) the date on which NHS England is given notice of the registration of the person with another provider of essential services (or their equivalent).

(9) NHS England must give notice in writing to—

(a) the person in respect of whom the removal is requested; and

(b) the contractor,

that the person's name has been or is to be removed from the contractor's list of patients on the date referred to in sub-paragraph (7) or (8).

Removal from the list of patients who are violent

24

(1) Where a contractor wants a person to be removed from its list of patients with immediate effect on the grounds that—

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

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

the contractor must give notice to NHS England in accordance with sub-paragraph (3).

(1A) Subject to sub-paragraph (1B), where a contractor—

(a) accepts a person onto its list of patients; and

(b) subsequently becomes aware that the person has previously been removed from the list of patients of another provider of primary medical services in response to a request for removal under paragraph (1),

the contractor may give notice to NHS England in accordance with sub-paragraph (3) that it wants to have the person removed from its list of patients with immediate effect.

(1B) A contractor must not give notice to NHS England pursuant to sub-paragraph (1A), where—

(a) a person mentioned in paragraph (1A) was allocated to a Violent Patient Scheme ... to receive primary medical services under that scheme; and

(b) the provider of the Scheme discharged that person because they were not considered to pose a risk of violence, or

(2) The persons specified in this sub-paragraph are—

(a) any party to the agreement who is an individual;

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

(d) any other person present—

(i) on the contractor's practice premises, or

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

(2A) For the purposes of sub-paragraph (1A), any reference to “the contractor” in sub-paragraph (2) is to be read as a reference to the other provider of primary medical services referred to in sub-paragraph (1A), and sub-paragraph (2) is to be construed accordingly.

(2B) In sub-paragraph (1B) “Violent Patient Scheme” means a scheme set up in accordance with the Primary Medical Services (Directed Enhanced Services) Directions to provide primary medical services to those removed from a contractor’s list of patients under paragraph (1).

(3) Notice under sub-paragraph (1) or (1A) may be given by any means but, if not in writing, must subsequently be confirmed in writing before the end of a period of seven days beginning with the date on which the notice was given.

(4) NHS England must acknowledge in writing receipt of a request from the contractor under sub-paragraph (1) or (1A).

(5) A removal requested in accordance with sub-paragraph (1) or (1A) takes effect at the time at which the contractor—

(a) makes a telephone call to NHS England; or

(b) sends or delivers the notice to NHS England.

(6) Where, under this paragraph, the contractor has given notice to NHS England that it wants to have a person removed from its list of patients, the contractor must inform that person of that fact unless—

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

(b) the contractor has reasonable grounds for believing that to do so would—

(i) be harmful to the person's physical or mental health, or

(ii) put the safety of a person specified in sub-paragraph (2) at risk.

(7) Where a person is removed from the contractor's list of patients in accordance with this paragraph, NHS England must give that person notice in writing of that removal.

(8) The contractor must record the removal of any person from its list of patients under this paragraph and the circumstances leading to that removal in the medical records of the person removed.

Removal from the list of patients registered elsewhere

25

(1) NHS England must remove a person from the contractor's list of patients if—

(a) the person has subsequently been registered with another provider of essential services (or their equivalent) in England; or

(b) NHS England has been given notice by a Local Health Board, a Health Board or a Health and Social Services Board that the person has subsequently been registered with a provider of essential services (or their equivalent) outside of England.

(2) A removal in accordance with sub-paragraph (1) takes effect—

(a) on the date on which NHS England is given notice of the person's registration with the new provider; or

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

(3) NHS England must give notice in writing to the contractor of any person removed from its list of patients under sub-paragraph (1).

Removal from the list of patients who have moved

26

(1) Subject to sub-paragraph (2), where NHS England is satisfied, or is notified by the contractor that a person on the contractor's list of patients has moved and no longer resides in the contractor's practice area, NHS England must—

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

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

(c) inform the person that if, after the end of the period of 30 days beginning with the date on which the advice mentioned in paragraph (b) was given, that person has not acted in accordance with that advice and informed NHS England accordingly, that person will be removed from the contractor's list of patients.

(2) If, at the end of period of 30 days mentioned in sub-paragraph (1)(c), NHS England has not been informed by the person of the action taken, NHS England must remove that person from the contractor's list of patients and inform that person and the contractor of that removal.

Removal from list of patients whose address is unknown

27

Where the address of a person who is on the contractor's list of patients is no longer known to NHS England, NHS England must—

(a) give notice in writing to the contractor that it intends, at the end of the period of three months beginning with the date on which notice was given, to remove the person from the contractor's list of patients; and

(b) at the end of the period referred to in sub-paragraph (a), remove the person from the contractor's list of patients unless, before the end of that period, the contractor satisfies NHS England that the person is a patient to whom the contractor is still responsible for providing essential services.

Removal from the list of patients absent from the United Kingdom etc.

28

(1) NHS England must remove a person from a contractor's list of patients where it is given notice to the effect that the person—

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

(b) is in the armed forces of the Crown (except in the case of a patient to whom paragraph 18 applies);

(c) is serving a term of imprisonment of more than two years or more than one term of imprisonment totalling, in the aggregate, more than two years;

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

(e) has died.

(2) The removal of a person from a contractor's list of patients under this paragraph takes effect from—

(a) where sub-paragraph (1)(a) to (c) applies—

(i) the date of the person's departure, enlistment or imprisonment, or

(ii) the date on which NHS England is given notice of the person's departure, enlistment or imprisonment,

whichever is the later; or

(b) where sub-paragraph (1)(d) and (e) applies, the date on which NHS England is given notice of the person's absence or death.

(3) NHS England must give notice in writing to the contractor of the removal of a person from the contractor's list of patients under this paragraph.

Removal from the list of patients accepted elsewhere as temporary residents

29

(1) NHS England must remove a person from a contractor's list of patients where the person has been accepted as a temporary resident by another contractor or other provider of essential services (or their equivalent) in any case where NHS England is satisfied, after due inquiry, that—

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

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

(2) NHS England must give notice in writing of any removal of a person from the contractor's list of patients under this paragraph—

(a) to the contractor; and

(b) where practicable, to that person.

(3) A notice given to a person under sub-paragraph (2)(b) must inform the person to whom it is given of—

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

(b) the name, postal and electronic mail address and telephone number of NHS England.

Removal from a list of pupils etc. of a school

30

(1) Where the contractor provides essential services under the agreement to persons on the grounds that they are pupils at, or staff or residents of, a school, NHS England must remove any such person from a contractor's list of patients who does not appear on the particulars provided by that school of persons who are pupils at, or staff or residents of, that school.

(2) Where NHS England has requested a school to provide the particulars referred to in sub-paragraph (1) and has not received those particulars, NHS England must consult the contractor as to whether it should remove from the contractor's list of patients any persons appearing in that list as pupils at, or staff or residents of, that school.

(3) NHS England must give notice in writing to the contractor of the removal of any person from the contractor's list of patients under this paragraph.

Termination of responsibility for patients not registered with the contractor

31

(1) Where the contractor has—

(a) received an application for the provision of medical services, other than essential services—

(i) from a person who is not included in the contractor's list of patients,

(ii) from a person that the contractor has not accepted as a temporary resident, or

(iii) made on behalf of a person referred to in paragraph (i) or (ii) by a person specified in paragraph 17(4); and

(b) accepted the person making the application or on whose behalf the application is made as a patient for the provision of the service in question,

the contractor's responsibility for that person terminates in the circumstances described in sub-paragraph (2).

(2) The circumstances described in this sub-paragraph are that—

(a) the contractor is informed that the person no longer wishes the contractor to be responsible for the provision of the service in question;

(b) in a case where the contractor has reasonable grounds for terminating its responsibility to provide the service to the person which do not relate to the person's age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class, the contractor informs the person that it no longer wants to be responsible for providing that person with the service in question; or

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

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

(3) Where a contractor wants to terminate its responsibility for a person under sub-paragraph (2)(b), the contractor must give notice of the termination to that person and the reason for it.

(4) The contractor must keep a written record of any terminations under this paragraph and of the reasons for those terminations and must make this record available to NHS England on request.

(5) A termination under sub-paragraph (2)(b) takes effect—

(a) where the grounds for termination are those specified in paragraph 24(1), from the date on which the notice is given; or

(b) in any other case, 14 days after the date on which the notice is given.

PART2A — List of patients: Crown servants posted overseas and their family members

CHAPTER1 — Interpretation of Part 2A

Meaning of “qualifying person”

31A

(1) A person (“P”) is a qualifying person for the purposes of this Part of this Schedule if—

(a) P is returning, or has returned, to the United Kingdom, and

(b) sub-paragraph (2), (3), (4) or (5) applies to P.

Civil servants posted overseas2This sub-paragraph applies to P if—aP is a civil servant who is, or, immediately before their return to the United Kingdom, was, posted overseas, orbwhere P is returning, or has returned, to the United Kingdom for a period of more than three months—iP was a civil servant who was posted overseas, andiiis returning, or has returned, to the United Kingdom (other than temporarily) for the first time since ceasing to be a civil servant.

Family members of Crown servants posted overseas3This sub-paragraph applies to P if P—ais a relevant family member of a person to whom sub-paragraph (2) applies (“R”), andbis, or, immediately before their return to the United Kingdom, was, accompanying R on the posting mentioned in sub-paragraph (2).4This sub-paragraph applies to P if P—ais a relevant family member of a civil servant (“C”) who—iis posted overseas, oriiwhere C is deceased, was at the time of their death posted overseas, andbis, or, immediately before their return to the United Kingdom, was, accompanying C on the posting mentioned in paragraph (a).5This sub-paragraph applies to P if—aP is a relevant family member of a person (“M”) who—iis a member of the armed forces of the Crown who is, or, immediately before their return to the United Kingdom, was posted overseas,iiwhere M is returning, or has returned, to the United Kingdom for more than three months—aawas a member of the armed forces of the Crown who was posted overseas, andbbis returning, or has returned, to the United Kingdom (other than temporarily) for the first time since ceasing to a member of those forces, oriiiwhere M is deceased, was at the time of their death a member of the armed forces of the Crown posted overseas, andbP is, or, immediately before their return to the United Kingdom, was, accompanying M on the posting mentioned in paragraph (a).6In this paragraph—“civil servant” means a person employed in the civil service of the State;“Crown servant” means—a civil servant, ora member of the armed forces of the Crown.7For the purposes of this paragraph “relevant family member”, in relation to a Crown servant (including a Crown servant who is deceased) (“C”), means—aC’s spouse or civil partner;ba person whose relationship with C has the characteristics of a relationship between spouses or civil partners;cC’s former spouse or former civil partner;da person whose relationship with C had the characteristics of a relationship between spouses or civil partners but which has ended (for any reason);eC’s widow, widower or surviving civil partner;fa dependent child.8For the purposes of sub-paragraph (7)(f), a person is a “dependent child” of a Crown servant if they are a child of the Crown servant and—athey—ihave not, or, when they departed the United Kingdom, had not, attained the relevant age, andiiare, or, where the Crown servant is deceased, were, wholly or mainly financially dependent on the Crown servant whilst accompanying the Crown servant on their overseas posting, orbthey are, or where the Crown servant is deceased, were, wholly or mainly financially dependent on the Crown servant because of a disability (within the meaning of section 6 of the Equality Act 2010).10For the purposes of sub-paragraph (8)(a)(i) “relevant age”—ain relation to a child of a civil servant, means the age of 21;bin relation to a child of a member of the armed forces of the Crown, means the age of 25.

Qualifying persons to be treated as previous patients of contractors

31B

(1) For the purposes of this Part of this Schedule, a qualifying person is required to be treated as a previous patient of a contractor if—

(a) where sub-paragraph (2) of paragraph 31A applies to P, P was removed from the contractor’s, or a predecessor contractor’s, list of patients under paragraph 28(1)(a) or (d) following the posting mentioned paragraph 31A(2) or a previous overseas posting;

(b) where sub-paragraph (3) of paragraph 31A applies to P, R (within the meaning of that sub-paragraph) was removed from the contractor’s, or a predecessor contractor’s, list of patients under paragraph 28(1)(a) or (d) following the posting mentioned paragraph 31A(2)or a previous overseas posting;

(c) where sub-paragraph (4) of paragraph 31A applies to P, C (within the meaning of that sub-paragraph) was removed from the contractor’s, or a predecessor contractor’s, list of patients under paragraph 28(1)(a) or (d) following the posting mentioned in paragraph 31A(4) or a previous overseas posting;

(d) where sub-paragraph (5) of paragraph 31A applies to P, P was removed from the contractor’s, or a predecessor contractor’s, list of patients under paragraph 28(1)(a) or (d) following P accompanying M (within the meaning of paragraph 31A(5)) on the posting mentioned paragraph 31A(5) or on a previous overseas posting.

(2) For the purposes of this paragraph, a contractor (“A”) is a predecessor contractor in relation to another contractor (“B”) if B assumes any of the obligations of A to provide services which were originally provided by A under A’s contract.

General interpretation of Part 2A

31C

(1) In this Part of this Schedule—

“child” means—a natural child,an adopted child, ora step-child;

“planned return date” means the date on which a person intends to return to the United Kingdom;

“qualifying person” has the meaning given in paragraph 31A;

“relevant family member” has the meaning given in paragraph 31A.

(2) For the purposes of this Part of this Schedule, a Crown servant is posted overseas if they—

(a) are performing overseas (but not in Northern Ireland) the duties of a civil servant or, as the case may be, a member of those forces overseas, and

(b) were immediately before their posting, or the first of consecutive postings, ordinarily resident in the United Kingdom.

(3) For the purposes of this Part of this Schedule, a relevant family member of a Crown servant who has not resided in the United Kingdom and is coming, or has come, to the United Kingdom for the first time is to be treated as if—

(a) they were returning, or had returned, to the United Kingdom, and

(b) they departed the United Kingdom on the day on which they became a relevant family member of the Crown servant.

(4) For the purposes of this Part of this Schedule, a person is to be regarded as temporarily resident in a place if, when that person arrives in that place, they intend to stay for more than 24 hours but not for more than three months.

CHAPTER2 — Crown servants and family members returning to the United Kingdom: registration with original or successor practice

Crown servants and family members returning to the United Kingdom for more than three months: inclusion in list of original practice or successor practice

31D

(1) Subject to sub-paragraph (4), a contractor must include a qualifying person in the contractor’s list of patients if the qualifying person (“P”) if—

(a) P is not registered as a patient with a provider of primary medical services,

(b) P is required to be treated as a previous patient of the contractor,

(d) either—

(i) P makes an application for inclusion in the contractor’s list of patients (a “list application”), or

(ii) where P is a person to whom sub-paragraph (2) applies, a list application is made on their behalf by an appropriate person.

(2) This sub-paragraph applies to a person if they—

(a) have not attained the age of 16 years, or

(b) lack the capacity to make a list application or authorise a person to make such an application on their behalf.

(3) For the purposes of sub-paragraph (1) it does not matter whether the contractor’s list of patients is open or closed.

(4) A list application—

(a) may be made on or after the date which is one month before the planned return date, but

(b) must be made before the end of the period of three months beginning with the day on which the person returns to the United Kingdom.

(5) Paragraph 28(1)(a) or (d) does not apply in respect of a qualifying person who is included in the contractor’s list of patients by virtue of sub-paragraph (1) before their return to the United Kingdom.

(6) Where a contractor accepts a list application, the contractor—

(a) must give notice in writing to NHS England of that acceptance (including the planned return date, where the application is made and accepted before that date) as soon as possible, but

(b) is not required to provide primary medical services to the qualifying person before their return to the United Kingdom.

(7) NHS England must, on receipt of a notice given under sub-paragraph (6)(a)—

(a) include the qualifying person in the contractor’s list of patients from the relevant date, and

(b) give notice in writing to the qualifying person or the appropriate person (as the case may be) of the acceptance.

(8) For the purposes of sub-paragraph (7)(a) “the relevant date” is—

(a) where the relevant list application is made after a person’s return to the United Kingdom, the date on which NHS England receives the notice given under sub-paragraph (7)(a);

(b) where the relevant list application is made before a person’s return to the United Kingdom, the later of—

(i) the planned return date, and

(ii) the date on which NHS England receives the notice given under sub-paragraph (7)(a).

(10) This paragraph is subject to paragraph 31H.

Crown servants and family members returning to the United Kingdom for three months or less: temporary registration with original or successor practice

31E

(1) Subject to sub-paragraph (5), a contractor must accept a qualifying person to whom sub-paragraph (2) applies (“P”) as a temporary resident provided that the contractor is satisfied that—

(a) if P is in the United Kingdom, P is not being provided with essential services (or their equivalent) under any other arrangement in the locality where P is temporarily residing, or

(b) if P is not yet in the United Kingdom, when P arrives in the United Kingdom, P will not be provided with essential services (or their equivalent) under any other arrangement in the locality where P will be temporarily residing.

(2) This sub-paragraph applies to a qualifying person if—

(a) they are returning, or have returned, to the United Kingdom for a period of more than 24 hours but not more than three months,

(b) they are required to be treated as a previous patient of the contractor, and

(i) they make an application to be accepted as a temporary resident by the contractor (a “temporary resident application”), or

(ii) where they are a person to whom sub-paragraph (3) applies, a temporary resident application is made on their behalf by an appropriate person.

(3) This sub-paragraph applies to a person if they—

(a) have not attained the age of 16 years, or

(b) lack the capacity to make a temporary resident application or authorise a person to make such an application on their behalf.

(4) For the purposes of sub-paragraph (1), it does not matter whether the contractor’s list of patients is open or closed.

(5) A temporary resident application may be made on or after the date which falls one month before the planned return date.

(6) Where a contractor accepts a temporary resident application, the contractor’s responsibility for the relevant qualifying person does not begin until the relevant date.

(7) Where a contractor wants to terminate its responsibility for a qualifying person accepted by it as a temporary resident under this paragraph before the end of the temporary residence period—

(a) the contractor must give notice, either orally or in writing, of that fact to the qualifying person or an appropriate person (as the case may be), and

(b) the contractor’s responsibility for the qualifying person is to cease seven days after the date on which the notice mentioned in paragraph (a) is given.

(8) The contractor must give notice in writing to NHS England of its acceptance of the qualifying person as a temporary resident—

(a) at the end of the period of three months beginning with the relevant date, or

(b) if the contractor’s period of responsibility for that person as a temporary resident came to an end earlier than the end of the three month period referred to in paragraph (a), at the end of that period.

(9) In this paragraph—

“relevant date” means the later of—the date on which the contractor accepts the qualifying person as a temporary resident, andthe date on which the qualifying person returns to the United Kingdom;

“the temporary residence period”, in relation to a qualifying person, means—the period of three months beginning with the relevant date, orsuch shorter period for which the contractor agreed to accept that person as a temporary resident.

(10) This paragraph is subject to paragraph 31H.

CHAPTER3 — Crown servants and family members returning to the United Kingdom: registration with a new practice

Crown servants and family members returning to the United Kingdom for more than three months: inclusion in list of patients of a new practice

31F

(1) A contractor must, if the contractor’s list of patient’s is open, include a qualifying person (“P”) in the contractor’s list of patients if—

(a) P is not registered as a patient with a provider of primary medical services,

(b) P is returning, or has returned, to the United Kingdom for a period of more than three months,

(d) either—

(i) P makes an application for inclusion in that list (a “list application”), or

(ii) where P is a person to whom sub-paragraph (2) applies, a list application is made on their behalf by an appropriate person.

(2) This sub-paragraph applies to a person if they—

(a) have not attained the age of 16 years, or

(b) lack the capacity to make a list application or authorise a person to make such an application on their behalf.

(3) A list application may be made during the period commencing one month prior to the planned return date and ending 24 hours prior to that date.

(4) Where a contractor’s list of patients is closed, the contractor may, by virtue of this sub-paragraph, accept a list application if the applicant is an immediate family member of a registered patient.

(5) Paragraph 28(1)(a) or (d) does not apply in respect of a qualifying person who is included in the contractor’s list of patients by virtue of sub-paragraph (1) before their return to the United Kingdom.

(6) Where a contractor accepts a list application, the contractor—

(a) must give notice in writing to NHS England of that acceptance (including the planned return date) as soon as possible, but

(b) is not required to provide primary medical services to the qualifying person before they return to the United Kingdom.

(7) NHS England must, on receipt of a notice given under sub-paragraph (6)(a)—

(a) include the qualifying person in the contractor’s list of patients from the relevant date, and

(b) give notice in writing to the qualifying person or the appropriate person (as the case may be) of the acceptance.

(9) For the purposes of paragraph (7)(a) “the relevant date” is the later of—

(a) the date on which NHS England receives the notice given under sub-paragraph (6)(a), and

(b) the planned return date.

(10) This paragraph is subject to paragraph 31H.

Crown servants and family members returning to the United Kingdom for three months or less: temporary registration with new practice

31G

(1) A contractor must, if the contractor’s list of patients is open, accept a qualifying person to whom sub-paragraph (2) applies (“P”) as a temporary resident provided that the contractor is satisfied that—

(a) if P is in the United Kingdom, P is not being provided with essential services (or their equivalent) under any other arrangement in the locality where P is temporarily residing, or

(b) if P is not yet in the United Kingdom, when P arrives in the United Kingdom, P will not be provided with essential services (or their equivalent) under any other arrangement in the locality where P will be temporarily residing.

(2) This sub-paragraph applies to a qualifying person if—

(a) they are returning, or have returned, to the United Kingdom for a period of at least 24 hours but not more than three months,

(b) they are not required to be treated as a previous patient of the contractor, and

(i) they make an application to be accepted as a temporary resident by the contractor (a “temporary resident application”), or

(ii) where they are a person to whom sub-paragraph (3) applies, a temporary resident application is made on their behalf by an appropriate person.

(3) This sub-paragraph applies to a person if they—

(a) have not attained the age of 16 years, or

(b) lack the capacity to make a temporary resident application or authorise a person to make such an application on their behalf.

(4) A temporary resident application may be made on or after the date which falls one month before the planned return date.

(5) Where a contractor accepts a temporary resident application, the contractor’s responsibility for the relevant qualifying person does not begin until the relevant date.

(7) Where a contractor wants to terminate its responsibility for a qualifying person accepted by it as a temporary resident under this paragraph before the end of the temporary residence period—

(a) the contractor must give notice, either orally or in writing, of that fact to the qualifying person or an appropriate person (as the case may be), and

(b) the contractor’s responsibility for the qualifying person is to cease seven days after the date on which the notice mentioned in paragraph (a) is given.

(8) The contractor must give notice in writing to NHS England of its acceptance of the qualifying person as a temporary resident—

(a) at the end of the period of three months beginning with the relevant date, or

(b) if the contractor’s period of responsibility for that person as a temporary resident came to an end earlier than the end of the three month period referred to in paragraph (a), at the end of that period.

(9) In this paragraph—

“relevant date” means the later of—the date on which the contractor accepts the qualifying person as a temporary resident, andthe date on which the qualifying person returns to the United Kingdom;

“the temporary residence period”, in relation to a qualifying person, means—the period of three months beginning with the relevant date, orsuch shorter period for which the contractor agreed to accept that person as a temporary resident.

(10) This paragraph is subject to paragraph 31H.

CHAPTER4 — Refusal of applications made under this Part

Refusal of an application under paragraphs 31D to 31G

31H

(1) The contractor may refuse a list application, or a temporary residence application, if (and only if) the contractor has reasonable grounds for doing so which do not relate to the qualifying person’s age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class.

(2) The reasonable grounds referred to in sub-paragraph (1) may, in the case of a list application, include the ground that the qualifying person will not, on or after the planned return date, live in, or does not intend to live in, either of the following areas—

(a) the contractor’s practice area, or

(b) the outer boundary area (the area referred to in regulation 13(2)).

(3) Where a contractor refuses a list application, or temporary resident application, the contractor must give a refusal notice to the relevant person before the end of the period of 14 days beginning with the date of the decision to refuse the application.

(4) For the purposes of sub-paragraph (3), the relevant person is—

(a) the applicant, or

(b) where the application was made on behalf of a person who has not attained the age of 16 years or a person who lacks capacity, the person who made the application on their behalf.

(5) The contractor must—

(a) keep a written record of—

(i) the refusal of any list application, and

(ii) its reasons for that refusal, and

(b) make such records available to NHS England on request.

(6) In this paragraph—

“list application” means an application under paragraph 31D or 31F;

“refusal notice” means a notice which—is in writing, andincludes the reasons for a decision to refuse the relevant application;

“temporary residence application” means an application under paragraph 31E or 31G.

PART 3 — List of patients: closure etc.

Application for closure of list of patients

32

(1) Where a contractor wants to close its list of patients, the contractor must send a written application to that effect (“the application”) to NHS England.

(2) The application must include the following information—

(a) the options which the contractor has considered, rejected or implemented in an attempt to alleviate the difficulties which the contractor has encountered in respect of its open list and, if any of the options were implemented, the level of success in reducing or extinguishing such difficulties;

(b) details of any discussions between the contractor and its patients and a summary of those discussions including whether or not, in the opinion of those patients, the list of patients should be closed;

(c) details of any discussions between the contractor and the other contractors in the contractor's practice area and a summary of the opinion of the other contractors as to whether or not the list of patients should be closed;

(d) the period of time, being a period of not less than three months and not more than 12 months, during which the contractor wants its list of patients to be closed;

(e) details of any reasonable support from NHS England which the contractor considers would enable its list of patients to remain open or would enable the period of proposed closure to be minimised;

(f) any plans which the contractor may have to alleviate the difficulties mentioned in the application during the period of the proposed closure in order for that list to re-open at the end of that period without the existence of those difficulties; and

(g) any other information which the contractor considers ought to be drawn to the attention of NHS England.

(3) NHS England must acknowledge receipt of the application before the end of the period of seven days beginning with the date on which the application was received by NHS England.

(4) NHS England must consider the application and may request such other information from the contractor as NHS England requires in order to enable it to decide the application.

(5) NHS England must enter into discussions with the contractor concerning—

(a) the support which NHS England may give to the contractor; or

(b) any changes which NHS England or the contractor may make,

which would enable the contractor to keep its list of patients open.

(6) NHS England and the contractor must, throughout the period of the discussions referred to in sub-paragraph (5), use reasonable endeavours to achieve the aim of keeping the contractor's list of patients open.

(7) NHS England or the contractor may, at any stage during the discussions, invite the Local Medical Committee (if any) for the area in which the contractor provides services under the agreement to attend any meetings arranged between NHS England and the contractor to discuss the application.

(8) NHS England may consult such persons as it appears to NHS England may be affected by the closure of the contractor's list of patients and, if it does so, NHS England must provide to the contractor a summary of the views expressed by those persons consulted in respect of the application.

(9) NHS England must enable the contractor to consider and comment on all the information before NHS England makes a decision in respect of the application.

(10) A contractor may withdraw the application at any time before NHS England makes a decision in respect of that application.

(11) NHS England must, before the end of the period of 21 days beginning with the date on which the application was received by NHS England (or within such longer period as the parties may agree), make a decision to—

(a) approve the application and determine the date from which the closure of the contractor's list is to take effect and the date on which the list of patients is to reopen; or

(b) reject the application.

(12) NHS England must give notice in writing to the contractor of its decision to—

(a) approve the application in accordance with paragraph 33; or

(b) reject the application in accordance with paragraph 34.

(13) A contractor may not submit more than one application to close its list of patients in any period of 12 months beginning with the date on which NHS England makes its decision on the application unless—

(a) paragraph 35 applies; or

(b) there has been a change in the circumstances of the contractor which affects its ability to deliver services under the agreement.

Approval of an application to close a list of patients

33

(1) Where NHS England approves an application to close a contractor's list of patients, NHS England must—

(a) give notice in writing to the contractor of its decision as soon as possible and the notice (“the closure notice”) must include the details specified in sub-paragraph (2); and

(b) at the same time as NHS England gives notice to the contractor, send a copy of the closure notice to—

(i) the Local Medical Committee (if any) for the area in which the contractor provides services under the agreement, and

(ii) any person who NHS England consulted in accordance with paragraph 32(8).

(2) The closure notice must include—

(a) the period of time for which the contractor's list of patients is to be closed which must be—

(i) the period specified in the application, or

(ii) where NHS England and the contractor have agreed in writing to a different period, that different period,

and, in either case, the period must not be less than three months and not more than 12 months;

(b) the date on which the closure of the contractor's list of patients is to take effect (“the closure date”); and

(3) Subject to paragraph 36, a contractor must close its list of patients with effect from the closure date and the list of patients must remain closed for the duration of the closure period as specified in the closure notice.

Rejection of an application to close a list of patients

34

(1) Where NHS England rejects an application to close a contractor's list of patients, NHS England must—

(a) give notice in writing to the contractor of its decision as soon as possible and the notice must include NHS England’s reasons for rejecting the application; and

(b) at the same time as NHS England gives notice to the contractor, send a copy of the notice to—

(i) the Local Medical Committee (if any) for the area in which the contractor provides services under the agreement, and

(ii) any person who NHS England consulted in accordance with paragraph 32(8).

(2) Subject to sub-paragraph (3), if NHS England decides to reject an application from a contractor to close its list of patients, the contractor may not make a further application to close its list of patients until whichever is the later of—

(a) the end of the period of three months beginning with the date on which NHS England’s decision to reject the application was made; or

(b) in a case where a dispute arising from NHS England’s decision to reject the application has been referred to the NHS dispute resolution procedure, the end of the period of three months beginning with the date on which a final determination to reject the application was made in accordance with that procedure (or any court proceedings).

(3) A contractor may make a further application to close its list of patients where there has been a change in the circumstances of the contractor which affects the contractor's ability to deliver services under the agreement.

Application for an extension of the closure period

35

(1) A contractor may apply to extend the closure period by sending a written application (“the application”) to that effect to NHS England no later than eight weeks before the date on which the closure period is due to expire.

(2) The application must include the following information—

(a) details of the options which the contractor has considered, rejected or implemented in an attempt to alleviate the difficulties which have been encountered during the closure period or which may be encountered when the closure period expires;

(b) the period of time during which the contractor wants its list of patients to remain closed (which may not be longer than 12 months);

(c) details of any reasonable support from NHS England which the contractor considers would enable the contractor's list of patients to re-open or would enable the proposed extension to the closure period to be minimised;

(d) details of any plans which the contractor may have to alleviate the difficulties mentioned in the application to extend the closure period in order for the list of patients to re-open at the end of the proposed extension of the closure period without the existence of those difficulties; and

(e) any other information which the contractor considers ought to be drawn to the attention of NHS England.

(3) NHS England must acknowledge receipt of the application before the end of the period of seven days beginning with the date on which the application was received by NHS England.

(4) NHS England must consider the application and may request such other information from the contractor as it requires in order to enable it to decide the application.

(5) NHS England may enter into discussions with the contractor concerning—

(a) the support which NHS England may give to the contractor; or

(b) any changes which NHS England or the contractor may make,

which would enable the contractor to re-open its list of patients.

(6) NHS England must determine the application before the end of the period of 14 days beginning with the date on which NHS England received that application (or before the end of such longer period as the parties may agree).

(7) NHS England must give notice in writing to the contractor of its decision to approve or reject the application as soon as possible after making that decision.

(8) Where NHS England approves the application, NHS England must—

(a) give notice in writing to the contractor of its decision (“the extended closure notice”) which must include the details specified in sub-paragraph (9); and

(b) at the same time as it gives notice in writing to the contractor, send a copy of the extended closure notice to—

(i) the Local Medical Committee (if any) for the area in which the contractor provides services under the agreement, and

(ii) any person who NHS England consulted in accordance with paragraph 32(8).

(9) The extended closure notice must include—

(a) the period of time for which the contractor's list of patients is to remain closed which must be—

(i) the period specified in the application, or

(ii) where NHS England and contractor have agreed in writing a different period to the period specified in that application, that agreed period,

and, in either case, the period (“the extended closure period”) must not be less than three months and not more than 12 months beginning with the date on which the extended closure period is to take effect ;

(b) the date on which the extended closure period is to take effect; and

(10) Where NHS England rejects an application, NHS England must—

(a) give notice in writing to the contractor of its decision which must include its reasons for rejecting the application; and

(b) at the same time as it gives notice to the contractor, send a copy of the notice to the Local Medical Committee (if any) for the area in which the contractor provides services under the agreement.

(11) Where an application is made in accordance with sub-paragraphs (1) and (2), the contractor's list of patients is to remain closed pending whichever is the later of—

(a) the determination by NHS England of that application; or

(b) in a case where a dispute arising from NHS England’s decision to reject the application has been referred to the NHS dispute resolution procedure, the contractor ceasing to pursue that dispute through that procedure (or any court proceedings).

Re-opening of list of patients

36

The contractor may re-open its list of patients before the expiry of the closure period if NHS England and the contractor agree that the contractor should do so.

PART 4 — Assignment of patients to lists

Application of this Part

37

(1) This Part applies in respect of the assignment by NHS England of—

(a) a person as a new patient to a contractor’s list of patients where that person—

(i) has been refused inclusion in a contractor’s list of patients or has not been accepted as a temporary resident by a contractor, and

(ii) would like to be included in the list of a contractor in whose integrated care board area that person resides;

(b) any person who is part of a list dispersal resulting from the closure of a practice where that person—

(i) has not registered with another contractor, and

(ii) would like to be included in the list of patients of a contractor in whose integrated care board area that person resides;

(c) any person who is part of a list dispersal resulting from the closure of a practice where that person has not registered with another contractor and NHS England has been unable to contact that person.

(2) In this paragraph, “list dispersal” means the allocation of patients from a contractor’s list of patients by NHS England following termination of the contract or during the period set out in the notice of termination or agreement to terminate.

Assignment of patients to list of patients: open and closed lists

38

(1) Subject to paragraph 39, NHS England may—

(a) assign a new patient to a contractor whose list of patients is open; and

(b) only assign a new patient to a contractor whose list of patients is closed in the circumstances specified in sub-paragraph (2).

(2) The circumstances specified in this sub-paragraph are where—

(a) the assessment panel has determined under paragraph 40(7) that new patients may be assigned to the contractor in question, and that determination has not been overturned either by a determination of the Secretary of State under paragraph 41(13) or (where applicable) by a court; and

(b) NHS England has entered into discussions with the contractor in question regarding the assignment of new patients if such discussions are required under paragraph 42.

Factors relevant to assignments

39

When assigning a person as a new patient to a contractor's list of patients under paragraph 38(1)(a) or (b), NHS England must have regard to—

(a) the preferences and circumstances of the person;

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

(c) any request made by a contractor to remove the person from its list of patients within the preceding period of six months beginning with the date on which the application for assignment is received by NHS England;

(d) whether, during the preceding period of six months beginning with the date on which the application for assignment is received by NHS England, the person has been removed from a list of patients on the grounds referred to in—

(i) paragraph 23 (relating to circumstances in which a patient may be removed from a contractor's list of patients at the request of the contractor),

(ii) paragraph 24 (relating to circumstances in which a patient who is violent may be removed from a contractor's list of patients), or

(iii) the equivalent provisions to those paragraphs in relation to arrangements made under section 83(2) of the Act (which relates to the provision of primary medical services) or under a contract made in accordance with the General Medical Services Contracts Regulations;

(e) in a case to which sub-paragraph (d)(ii) applies (or to which the equivalent provisions as mentioned in sub-paragraph (d)(iii) apply), whether the contractor has appropriate facilities to deal with such patients; and

(f) such other matters as NHS England considers relevant.

Assignment of patients from outside practice area

39A

Where NHS England has assigned a person to a contractor’s list of patients in accordance with this Part, and that person resides outside a contractor’s practice area, regulation 25(4), (5) and (6) (variation of contracts: registered patients from outside practice area) are to apply as if the contractor had accepted that patient onto its list of patients in accordance with regulation 25(1), unless a contractor chooses to include that person in its list of patients for its practice area on assignment by NHS England.

Assignments to closed lists: composition and determinations of the assessment panel

40

(1) Where NHS England wants to assign a new patient to a contractor which has closed its lists of patients, NHS England must prepare a proposal to be considered by the assessment panel.

(2) NHS England must give notice in writing to—

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