The General Medical Services Transitional and Consequential Provisions (Wales) Order 2004

• (ii) as a payment under the general medical services contract, shall be treated as a payment under the general medical services contract,

and accordingly any condition that attaches, or is to be attached, to such a payment, when made under a general medical services contract, by virtue of the Statement of Financial Entitlements or the Premises Costs Directions, is attached to that payment; and

• (d) where appropriate, contains a condition to the effect that any payment that has been made under the default contract pursuant to article 36(8) is set off, equitably, against any payment for equivalent services provided under the general medical services contract.

Persons not able to enter into a default contract

41

• (1) Where a person to whom article 13(2) or (3) applies is unable to enter into a default contract because the Local Health Board with whom that person would have entered into a default contract is not satisfied of the matters specified in paragraphs (5) or (6) of that article or because he or she is performing relevant service, that Local Health Board may pay to that person any payment that he or she would have been entitled to receive under the default contract, had he or she been able to enter into a default contract, or may pay him or her a proportion thereof (having regard, amongst other matters, to the cost of any temporary arrangements made by the Local Health Board for the provision of primary medical services to his or her patients) for as long as he or she is not able to enter into—

• (a) a general medical services contract; or

• (b) a default contract following an appeal under article 13(9),

but he or she remains entitled to enter into a general medical services contract.

• (2) Where a person to whom payments have been made by a Local Health Board by virtue of paragraph (1) enters into a default contract or a general medical services contract, the Local Health Board that is a party to the contract must ensure that the contract—

• (a) contains a condition to the effect that all rights to further payments under paragraph (1) are surrendered (they are hereby extinguished);

• (b) takes effect, for payment purposes, on 1st April 2004;

• (c) in the case of a general medical services contract, contains a condition to the effect that any payment that has been made under paragraph (1) that could have been made—

• (i) as a payment on account under the general medical services contract, shall be treated as a payment on account under the general medical services contract (and for these purposes any payment of one twelfth of a final global sum equivalent made under paragraph (1) shall be treated as a payment on account in respect of a payable global sum monthly payment),

• (ii) as a payment under the general medical services contract, shall be treated as a payment under the general medical services contract,

and accordingly any condition that attaches, or is to be attached, to such a payment, when made under a general medical services contract, by virtue of the Statement of Financial Entitlements or the Premises Costs Directions, is attached to that payment; and

• (d) in the case of a default contract, contains a condition to the effect that any payment that has been made under paragraph (1) that could have been made as a payment under the default contract, had the contractor entered into the default contract on or before 31st March 2004, shall be treated as a payment under the default contract, and accordingly any condition attached to such a payment by virtue of this Order is attached to that payment.

Claims under the Statement of Fees and Allowances

42

• (1) Notwithstanding the repeal of the 1992 Regulations, claims may still be made for payments under the Statement of Fees and Allowances by any person who may be entitled to such a payment, provided that the claim is made within any period stipulated in the Statement of Fees and Allowances as being the period during which a claim for the payment is to be made.

• (2) If a claim is made outside that stipulated period, the Local Health Board may extend that period for up to six years from the date on which the circumstances which gave rise to the claim first arose.

• (3) If the Local Health Board refuses the claim, or considers that the amount to be paid out in respect of the claim is significantly lower than the amount claimed, the arrangements for appeals set out in paragraph 80 of the Statement of Fees and Allowances are to apply.

PART 6 — MISCELLANEOUS

Modification of section 4(5) of the National Health Service and Community Care Act 1990

43

For the purposes of disputes relating to—

• (a) general medical services contracts; or

• (b) personal medical services agreements under section 28C of 1977 Act,

which are referred to the Assembly[^f00048] under section 4(3) or (4) of the 1990 Act (NHS contracts), section 4(5) of that Act shall be read as if after “appoint a person” there were included “or persons”.

Signed

Signed on behalf of the National Assembly for Wales under section 66(1) of the Government of Wales Act 1998[^f00049]

D.Elis-Thomas — The Presiding Officer of the National Assembly — 26th February 2004

Explanatory note

(This note is not part of the Order)

This Order sets out transitional arrangements to cover the replacement of arrangements for general medical services under section 29 of the National Health Service Act 1977 with general medical services contracts under section 28Q of that Act (as inserted by section 175(1) of the Health and Social Care (Community Health and Standards) Act 2003 (“the Act”)).

Part 2 of the Order sets out the circumstances in which those currently providing general medical services will be entitled to enter into a general medical services contract and, if they are unable to enter into such a contract on or before 31st March 2004, a default contract under section 176(3) of the Act. It also sets out the arrangements for medical practitioners who are suspended, unable to provide services under a contract on grounds of physical or mental ill-health or performing relevant service. Articles 4, 10 and 12 provide a right of appeal to the Assembly where a Local Health Board refuses to enter into a general medical services or a default contract because it is not satisfied that the criteria relating to suspended or unfit medical practitioners are met or where the Local Health Board has failed to enter into a general medical services contract by the time a person’s entitlement to such a contract expires.

Part 3 provides for the continuation of arrangements by the Local Health Board to provide primary medical services to the patients of medical practitioners who are suspended or unable to perform services on the grounds of physical or mental ill-health.

Articles 15 to 22 specify the services which must be provided in default contracts and certain types of general medical services contracts. Articles 23 and 24 prescribe the premises which must be specified in default and general medical services contracts entered into on or before 31st March and the practice area which must be specified in default contracts. Articles 25 to 29 specify who must be included in the list of patients for default contracts and certain types of general medical services contracts and whether that list must be open or closed to applications from patients. Article 30 deals with the procedure for dispute resolution in default contracts.

Part 5 sets out the financial arrangements for default contracts.

Footnotes

[^f00001]: 2003 c. 43.

[^f00002]: 1983 c. 54.

[^f00003]: 1990 c. 19.

[^f00004]: S.I. 1992/635.

[^f00005]: S.I. 2004/478 (W.48).

[^f00006]: 1971 c. 80.

[^f00007]: S.I. 1998/668 as amended by S.I. 1999/3179 and S.I. 2000/1708 (W.115).

[^f00008]: Section 495 was inserted into the 1977 Act by section 27(1) of the Health and Social Care Act 2001 (c. 15) (“the 2001 Act”) and amended by the National Health Service Reform and Health Care Professions Act 2002 (c. 17) (“the 2002 Act”), Schedule 1, paragraph 18.

[^f00009]: Section 44 was amended by the Health and Social Security Act 1984 (c. 48). Section 24 and Schedule 8, the 1990 Act, section 12(4), the Health Authorities Act 1995 (c. 17), Schedule 1, paragraph 32(a), the Health Act 1999 (c. 8), section 11, the 2001 Act, section 43(6) and Schedule 5, paragraph 5(7), the 2002 Act, section 5 and was repealed in relation to Local Medical Committees by the 2003 Act, Schedule 11, paragraph 21.

[^f00010]: Section 45A was inserted into the 1977 Act by paragraph 23 of Schedule 1 to the 2003 Act.

[^f00011]: Section 29(2)(a) was inserted into the 1977 Act by paragraph 23 of Schedule 1 to the 2003 Act.

[^f00012]: Section 28X was inserted into the 1977 Act by section 179(1) of the 2003 Act.

[^f00013]: 1983 c. 54.

[^f00014]: Regulation 13 was substituted by S.I. 1998/2838 and amended by S.I. 2002/916 (W.104)

[^f00015]: Section 29 was amended by the Health Services Act 1980 (c. 53), section 7, the Health and Social Services and Social Security Adjudications Act 1983 (c. 41), Schedule 6, paragraph 2, the Medical Act 1983 (c. 54), Schedule 5, paragraph 16(a), the Health Authorities Act 1995 (c. 17), Schedule 1, paragraph 18, the Medical (Professional Performance) Act 1995 (c. 51), Schedule,paragraph 28(b), the National Health Service (Primary Care) Act 1997 (c. 46), Schedule 2, paragraph 8, the 2001 Act, sections 17 and 23, the 2002 Act Schedule 2, paragraph 3 and Schedule 8, paragraph 2 and S.I.s 1985/39 and 2002/3135. It is to be repealed from 1st April by section 175(2) of the 2003 Act.

[^f00016]: Regulation 4(1)(a) was amended by S.I. 1998/682 and 2838 and 2002/2469.

[^f00017]: Regulation 19 was amended by S.I. 1994/633, 1998/682 and 2002/2469.

[^f00018]: Regulations 18A and 18B were substituted by S.I. 1998/2838 and amended by S.I. 2002/554 and 2469.

[^f00019]: Regulation 25(6) was amended by S.I. 2002/2469.

[^f00020]: Section 36A was inserted by the Medical (Professional Performance) Act 1995 (c. 51), section 1 and amended by S.I. 2000/1803; section 38(1) was amended by paragraph 7 of the Schedule to that Act; paragraph 5A was inserted by paragraph 20 of the Schedule to that Act. All three provisions are prospectively substituted by S.I. 2002/3135.

[^f00021]: Section 37 was amended by the Medical (Professional Performance) Act 1995 (c. 51), Schedule, paragraph 6(2) to (4). It is prospectively substituted by S.I. 2002/3135.

[^f00022]: Section 41A was inserted by S.I. 2000/1803. It is prospectively substituted by S.I. 2002/3135

[^f00023]: S.I. 2002/3135. This Order substitutes the sections referred to in article 3(5).

[^f00024]: Regulation 25(9) was amended by S.I. 2002/2469.

[^f00025]: Regulation 18F(1) was substituted by S.I. 1998/2838 and amended by S.I. 2001/3742 and 2002/554 and 2469.

[^f00026]: Regulation 18G was substituted by S.I. 1998/2838 and amended by S.I. 2001/3742 and 2002/554 and 2469; regulation 18GG was inserted by S.I. 2001/3742 and amended by S.I. 2002/2469.

[^f00027]: The Default Contract 2004 is published by the Department of Health. It is available on their web site at www.dh.gov.uk or a copy can be obtained by writing to the Department of Health, P.O. Box 777, London SE1 6XH.

[^f00028]: Regulation 25(6) was amended by S.I. 2002/2469.

[^f00029]: Regulation 25(2) was amended by S.I. 1995/3093, 1998/682, 2001/3742 and 2002/2469.

[^f00030]: Regulation 25(11) was amended by S.I. 2002/2469.

[^f00031]: Paragraph 14A was inserted by S.I. 1995/3093 and amended by S.I. 2001/3742 and 2002/2469.

[^f00032]: Regulation 18D was substituted by S.I. 1998/2838 and amended by S.I. 2002/554 and 2469.

[^f00033]: Paragraph 18(2) was amended by S.I. 2002/2469.

[^f00034]: Section 29 was amended by the Health Services Act 1980 (c. 53), section 7, the Health and Social Services and Social Security Adjudications Act 1983 (c. 41), Schedule 6, paragraph 2, the Medical Act 1983 (c. 54), Schedule 5, paragraph 16(a), the Health Authorities Act 1995 (c. 17), Schedule 1, paragraph 18, the Medical (Professional Performance) Act 1995 (c. 51), Schedule,paragraph 28(b), the National Health Service (Primary Care) Act 1997 (c. 46), Schedule 2, paragraph 8, the 2001 Act, sections 17 and 23, the 2002 Act Schedule 2, paragraph 3 and Schedule 8, paragraph 2 and S.I.s 1985/39 and 2002/3135. It is to be repealed from 1st April 2004 by section 175(2) of the 2003 Act.

[^f00035]: Regulation 28 was amended by S.I. 2002/2469.

[^f00036]: Regulation 29 was amended by S.I. 1998/682.

[^f00037]: Regulation 31 was amended by S.I. 1998/682 and 2002/2469.

[^f00038]: Regulation 29 was amended by S.I. 2002/554 and 2469; regulation 29A was inserted by S.I. 1995/80 and amended by S.I. 2002/554 and 2469

[^f00039]: Regulation 19 was amended by S.I. 1994/633, 1998/682 and 2002/2469.

[^f00040]: Regulation 4 was amended by S.I. 1999/3179 and 2000/1708 (W.115).

[^f00041]: Regulation 4 was amended by S.I. 1999/3179 and 2002/2469.

[^f00042]: Regulation 25(2) was amended by S.I. 1995/3093, 1998/682, 2001/3742 and 2002/2469; regulation 25(6) was amended by S.I. 2002/2469.

[^f00043]: Regulation 4(8) was amended by S.I. 2002/2469.

[^f00044]: Section 16BB(4) was inserted into the Act by section 6 of the National Health Service Reform and Health Care Professions Act 2003 (c. 17).

[^f00045]: 1977 c. 49.

[^f00046]: Regulation 34 was amended by S.I. 1993/540, 1997/2468, 2000/601 and 2002/2469.

[^f00047]: Section 28T was inserted into the Act by section 175 of the Health and Social Care (Community Health and Standards) Act 2003.

[^f00048]: Functions of the Secretary of State, so far as exercisable in relation to Wales, were transferred to the National Assembly for Wales by the National Assembly for Wales (Transfer of Functions) Order S.I. 1999/672, article 2, Schedule 1.

[^f00049]: 1998 c. 38.