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The National Health Service (General Medical Services Contracts) (Wales) Regulations 2023

Type Welsh-Statutory-Instrument

Publication 2023-09-01

Last updated 2026-03-28

State In force

Jurisdiction Wales

Department King's Printer of Acts of Parliament

Source legislation.gov.uk

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(a) subject to the requirements of this paragraph(11), cease performing any work or carrying out any obligations under the contract,

(b) co-operate with the Local Health Board to enable any outstanding matters under the contract to be dealt with or concluded in a satisfactory manner,

(c) co-operate with the Local Health Board to enable the contractor’s patients to be transferred to one or more other contractors or providers of unified services (or their equivalent), which must include—

(i) providing reasonable information about individual patients, and

(ii) delivering patient records

to such other appropriate person or persons as the Local Health Board specifies, and

(d) deliver up to the Local Health Board all property belonging to the Local Health Board including all documents, forms, computer hardware and software, drugs, appliances or medical equipment which may be in the contractor’s possession or control.

Other contractual terms

29

(1) A contract must, unless it is of a type or nature to which a particular provision does not apply, contain, other terms which have, the same effect as those specified in Schedule 3 except paragraphs 45(5) to (9), 46(5) to (17), 106(5) to (14), and 107.

(2) The paragraphs specified in paragraph (1) have effect in relation to the matters set out in those paragraphs.

PART 6 — Functions of Local Medical Committees

30

(1) The functions of a Local Medical Committee which are prescribed for the purposes of section 54(7) of the Act (Local Medical Committees) are—

(a) the consideration of any complaint made to it by any medical practitioner against a medical practitioner specified in paragraph (2) providing services under a contract in the relevant area involving any question of the efficiency of those services,

(b) the reporting of the outcome of the consideration of any such complaint to the Local Health Board with whom the contract is held in cases where that consideration gives rise to any concerns relating to the efficiency of services provided under a contract,

(c) the making of arrangements for the medical examination of a medical practitioner specified in paragraph (2), where the contractor or the Local Health Board is concerned that the medical practitioner is incapable of adequately providing services under the contract and it so requests with the agreement of the medical practitioner concerned, and

(d) the consideration of the report of any medical examination arranged in accordance with sub-paragraph (c) and the making of a written report as to the capability of the medical practitioner of adequately providing services under the contract to the medical practitioner concerned, the contractor and the Local Health Board with whom the contractor holds a contract.

(2) The medical practitioner referred to in paragraph (1)(a) and (c) is a medical practitioner who is—

(a) a contractor,

(b) one of two or more persons practising in partnership which holds a contract, or

(3) In this regulation, “the relevant area” means the area for which the Local Medical Committee is formed.

PART 7 — General transitional provision and saving, consequential amendments and revocations

General transitional provision and saving

31

(1) This regulation applies to—

(a) the exercise by the Local Health Board of any of its functions under the 2004 Regulations before the commencement date, and

(b) any rights or liabilities of the Local Health Board in respect of the exercise of any of its functions under the 2004 Regulations.

(2) Subject to paragraph (4), any act or omission concerning a contract to which the 2004 Regulations applied immediately before the commencement date in respect of any of the matters specified in paragraph (1), is to be treated as an act or omission concerning a contract to which these Regulations apply.

(3) Subject to paragraph (4), anything which, before the commencement date, is done or is in the process of being done under the 2004 Regulations concerning a contract to which the 2004 Regulations applied immediately before that date in respect of any of the matters specified in paragraph (1), is to be treated as if done or in the process of being done under these Regulations.

(4) Notwithstanding paragraphs (2) and (3) and the revocations provided for in Schedule 6, where the 2004 Regulations contain a provision for which there is no equivalent provision in these Regulations (“the relevant provision”), the 2004 Regulations, as they were in force immediately before the commencement date, are to continue to apply to the extent necessary for the purposes of—

(a) preserving any rights conferred or liabilities accrued by or under the relevant provision, or

(b) the assessment or determination of any rights or liabilities arising under or in accordance with the relevant provision.

(5) In this regulation—

“the commencement date” (“y dyddiad cychwyn”) means the date on which these Regulations come into force; ...

“contract” (“contract”) includes any contract to which the 2004 Regulations applied immediately before the commencement date under which medical services were provided before the commencement date (whether or not such services continued to be provided after that date).

Consequential amendments

32

Schedule 5 makes provision in respect of the amendments to secondary legislation which are consequential upon the coming into force of these Regulations.

Revocations

33

Schedule 6 makes provision in respect of the revocation of the enactments specified.

SCHEDULE 1 — List of Prescribed Medical Certificates

Description of medical certificate	Enactment under or for the purpose of which certificate required
1. To support a claim or to obtain payment either personally or by proxy; to prove incapacity to work or for self-support for the purposes of an award by the Secretary of State; or to enable proxy to draw pensions etc.	Naval and Marine Pay and Pensions Act 1865 (c. 73) Air Force (Constitution) Act 1917 (c. 51) Pensions (Navy, Army, Air Force and Mercantile Marine) Act 1939 (c. 83) Personal Injuries (Emergency Provisions) Act 1939 (c. 82) Social Security Administration Act 1992 (c. 5) Social Security Contributions and Benefits Act 1992 (c. 4) Social Security Act 1998 (c. 14)
2. To establish pregnancy for the purpose of obtaining welfare foods	Section 13 of the Social Security Act 1988 (benefits under schemes for improving nutrition: pregnant women, mothers and children)
3. To secure registration of still-birth	Section 11 of the Births and Deaths Registration Act 1953 (c. 20) (special provision as to registration of still-birth)
4. To enable payment to be made to an institution or other person in case of mental disorder of persons entitled to payment from public funds	Section 142 of the Mental Health Act 1983 (c. 20) (pay, pensions etc., of mentally disordered persons)
5. To establish unfitness for jury service	Juries Act 1974 (c. 23)
6. To support late application for reinstatement in civil employment or notification of non-availability to take up employment owing to sickness	Reserve Forces (Safeguard of Employment) Act 1985 (c. 17)
7. To enable a person to be registered as an absent voter on grounds of physical incapacity	Representation of the People Act 1983 (c. 2)
8. To support applications for certificates conferring exemption from charges in respect of drugs	National Health Service Act 2006 (c. 41)
9. To support a claim by or on behalf of a person with a significant cognitive impairment for exemption from liability to pay the Council Tax or eligibility for a discount in respect of the amount of Council Tax payable	Local Government Finance Act 1992 (c. 14)

SCHEDULE 2 — Further details about specific Unified Services

Cervical screening

1

(1) A contractor must—

(a) provide all the services described in sub-paragraph (2), and

(b) make the records specified in sub-paragraph (4) within the patient’s record kept in accordance with paragraph 78 of Schedule 3.

(2) The services referred to in sub-paragraph (1)(a) are—

(a) the provision of any necessary information and advice to assist relevant patients in making an informed decision as to participation in the Cervical Screening Wales Programme undertaken by Public Health Wales (the “Programme”),

(b) performing cervical screening tests on people who have agreed to participate in that Programme,

(d) ensuring that test results are followed up as clinically appropriate.

(3) For the purposes of sub-paragraph (2)(a) “relevant patients” means patients on the contractor’s patient list who have been identified by Public Health Wales as suitable candidates for a cervical screening test.

(4) The records referred to in sub-paragraph (1)(b) are—

(a) an accurate record of the cervical screening test undertaken, and

(b) the result of any test undertaken, and

Child health surveillance

2

(1) A contractor must in respect of any child under the age of 5 for whom it has responsibility under the contract—

(a) provide all the services described in sub-paragraph (2), other than any examination so described which a parent refuses to allow their child to undergo, until the date on which the child attains 5 years of age, and

(b) maintain the records specified in sub-paragraph (3).

(2) The services referred to in sub-paragraph (1)(a) are—

(a) the monitoring of the health, well-being and physical, mental and social development (which together are referred to in this paragraph as “development”) of a child under 5 years of age with a view to detecting any deviations from normal development—

(i) by the consideration of any information concerning the child received by or on behalf of the contractor, and

(ii) on any occasion when the child is examined or observed by or on behalf of the contractor (whether pursuant to paragraph (b) or otherwise);

(b) the examination of a child at a frequency that has been agreed with the Local Health Board in accordance with the nationally agreed evidence based programme set out in the latest clinical guidance in relation to the Newborn and Infant Physical Examination Cymru, and the Local Health Board or the contractor may seek the views of the relevant Local Medical Committee prior to reaching agreement on the appropriate frequency of such examinations.

(3) The records specified for the purposes of sub-paragraph (1)(b) must be an accurate record of—

(a) the development of the child while under 5 years of age, compiled as soon as is reasonably practicable following the first examination of that child and, where appropriate, amended following each subsequent examination, and

(b) the responses (if any) to offers made to the child’s parent for the child to undergo any examination referred to in sub-paragraph (2)(b).

Childhood vaccinations and immunisations services

3

(1) A contractor must comply with the requirements in sub-paragraphs (2) and (3).

(2) The contractor must—

(a) offer to provide to children for whom the contractor has responsibility under the contract all vaccinations and immunisations of a type and in the circumstances specified in the relevant Annex of the GMS Statement of Financial Entitlements;

(b) provide appropriate information and advice to patients and, where appropriate, their parents, about such vaccinations and immunisations;

(c) record in the patient’s record kept in accordance with paragraph 78 of Schedule 3 any refusal of the offer referred to in paragraph (a);

(d) where the offer is accepted, administer the vaccinations and immunisations and include in the patient’s record kept in accordance with paragraph 78 of Schedule 3—

(i) the name of the person who gave consent to the vaccination or immunisation and that person’s relationship to the patient,

(ii) the batch numbers, expiry date and title of the vaccine,

(iii) the date of administration,

(iv) in a case where two vaccines are administered in close succession, the route of administration and the injection site of each vaccine,

(v) any contra-indications to the vaccination or immunisation, and

(vi) any adverse reactions to the vaccination or immunisation.

(3) The contractor must ensure that all staff involved in administering vaccines are trained and their knowledge kept up to date in the recognition and initial treatment of anaphylaxis.

Contraceptive services

4

A contractor must make available to all its patients who so request them, those services described in sub-paragraphs (a) to (g)—

(a) the giving of advice about the full range of contraceptive methods,

(b) where appropriate, the medical examination of patients seeking such advice,

(c) the treatment of such patients for contraceptive purposes and the prescribing of contraceptive substances and appliances (excluding the fitting and implanting of intrauterine devices and implants),

(d) the giving of advice about emergency contraception and where appropriate, the supplying or prescribing of emergency hormonal contraception or, where the contractor has a conscientious objection to emergency contraception, prompt referral to another provider of primary medical services who does not have such conscientious objections,

(e) the provision of advice and referral in cases of unplanned or unwanted pregnancy, including advice about the availability of free pregnancy testing in the practice area and, where appropriate, where the contractor has a conscientious objection to the termination of pregnancy, prompt referral to another provider of primary medical services who does not have such conscientious objections,

(f) the giving of initial advice about sexual health promotion and sexually transmitted infections, and

(g) the referral as necessary for specialist sexual health services, including home testing or self-testing kits for sexually transmitted infections.

Maternity medical services

5

(1) A contractor must provide all the necessary maternity medical services to—

(a) patients who have been diagnosed as pregnant throughout the antenatal period;

(b) patients and their babies throughout the postnatal period, other than neonatal checks;

(c) patients whose pregnancy has terminated as a result of miscarriage or abortion or, where the contractor has a conscientious objection to the termination of pregnancy, the contractor must promptly refer the patient to another provider of primary medical services who does not have such conscientious objections.

(2) In this paragraph—

“antenatal period” (“cyfnod cynenedigol”) means the period from the start of the pregnancy to the onset of labour;

“maternity medical services” (“gwasanaethau meddygol mamolaeth”) means—in relation to patients (other than babies) all primary medical services relating to pregnancy, excluding intra partum care; andin relation to babies, any primary medical services necessary to their first 14 days of life;

“neonatal check” (“gwiriad newydd-anedig”) means the examination of the baby in the first month after birth;

“postnatal period” (“cyfnod ôl-enedigol”) means the period beginning with the conclusion of delivery of the baby or the patient’s discharge from secondary care services, whichever is the later, and ending with the 14th day after the birth.

Minor surgery

6

A contractor must—

(a) make available to patients, cryocautery, curettage and cautery of warts, verrucae and other skin lesions where clinically appropriate, and

(b) ensure that its record of any treatment provided under this paragraph includes—

(i) details of the minor surgery provided to the patient, and

(ii) the consent of the patient to that treatment.

Vaccinations and immunisations

7

(1) A contractor must—

(a) offer to administer or provide to patients all vaccinations and immunisations of a type and in the circumstances specified in the relevant Annex to the GMS Statement of Financial Entitlements and that are funded under the global sum;

(b) provide appropriate information and advice to patients and, where appropriate, to the parents of patients, about such vaccinations and immunisations;

(c) in relation to patients other than children and taking into account the individual circumstances of the patient, consider whether—

(i) immunisation ought to be administered by the contractor or by a health care professional employed or engaged by the contractor, or

(ii) a prescription form ought to be provided for the purpose of self-administration by the patient of the immunisation;

(d) record in the patient’s record any refusal of the offer mentioned in paragraph (a);

(e) where—

(i) the offer mentioned in paragraph (a) is accepted, and

(ii) in case of a patient who is not a child, the immunisation is to be administered by the contractor or another health care professional,

administer the immunisations and record the immunisation information in the patient’s record, using codes agreed by the Local Health Board for this purpose;

(f) where—

(i) the offer mentioned in paragraph (a) is accepted, and

(ii) in the case of a patient who is not a child, the immunisation is not to be administered by the contractor or another health care professional,

issue a prescription form for the purposes of self-administration by the patient.

(2) For the purposes of this paragraph—

“immunisation information” ... means—either—the patient’s consent to immunisation, orwhere another person consents to immunisation on behalf of the patient, the name of the person who gave that consent and their relationship to the patient;the batch number, expiry date and title of the vaccine,the date of administration of the vaccine,where two vaccines are administered by injections, in close succession, the route of administration and the injection site of each vaccine,any contraindications to the vaccine, andany adverse reactions to the vaccine.

(3) The contractor must ensure that all staff involved in administering vaccines are trained and their knowledge kept up to date in the recognition and initial treatment of anaphylaxis.

8

For the purposes of paragraphs 1 to 7 “a patient’s record” means the record which is kept in relation to a patient in accordance with paragraph 78 of Schedule 3.

SCHEDULE 3 — Other contractual terms

PART 1 — Provision of services

Premises, facilities and equipment

1

(1) The contractor must ensure that the premises used for the provision of services under the contract—

(a) are suitable for the delivery of those services,

(b) are sufficient to meet the reasonable needs of the contractor’s patients, and

(2) The requirement in sub-paragraph (1) is subject to any plan included in the contract in accordance with regulation 18(5) which sets out steps to be taken by the contractor to bring the premises up to the required standard.

(3) In relation to each service it provides, the contractor must provide such facilities and equipment as are necessary to enable it properly to perform that service.

Telephone services

2

(1) The contractor must not be a party to any contract or other arrangements under which the number for telephone services to be used—

(a) by patients to contact the practice for any purpose related to the contract, or

(b) by any other person to contact the practice in relation to services provided as part of the health service,

starts with the digits 084, 087, 090 or 091 or consists of a personal number, unless the service is provided free to the caller.

(2) The contractor must ensure their telephone lines are ...—

(a) staffed for the duration of core hours, unless any agreement has been reached between the Local Health Board and the contractor pursuant to regulation 18(7) which allows the use of an answer phone message for temporary periods, and

(b) answered by appropriately qualified members of the contractor’s staff that are located within the United Kingdom.

(3) In this paragraph, “personal number” means a telephone number which starts with the number 070 followed by a further 8 digits.

Cost of relevant calls

3

(1) The contractor must not enter into, renew or extend a contract or other arrangement for telephone services unless it is satisfied that, having regard to the arrangement as a whole, persons are not going to have to pay more to make relevant calls to the contractor’s practice than they would to make equivalent calls to a geographical number.

(2) In this paragraph—

“geographical number” (“rhif daearyddol”) means a number which has a geographical area code as its prefix;

“relevant calls” (“galwadau perthnasol”) means—calls made by patients to the contractor’s practice for any reason related to services provided under the contract, andcalls made by persons, other than patients, to the practice in relation to services provided as part of the health service.

Access

4

(1) The contractor must—

(a) have a telephone system with a recording function for incoming and outgoing lines, that stacks calls and allows for the analysis of call data,

(b) have a telephone introduction message recorded bilingually in Welsh and English that in total lasts no longer than 2 minutes,

(d) for the duration of core hours, ensure that patients can digitally request a non-urgent appointment or a call back, and that the necessary governance arrangements are in place for this process,

(e) publicise information via the practice’s online resource on—

(i) the access requirements specified in this paragraph 4, and

(ii) how patients can—

(aa) access the contractor’s services, and

(bb) request an urgent, routine and advanced consultation,

(f) offer a same day consultation for—

(i) children under 16 with acute presentations, and

(ii) patients clinically triaged as requiring an urgent assessment,

(g) offer pre-bookable appointments to take place during core hours; and

(h) actively signpost patients to appropriate services—

(i) available from the members of the contractor’s cluster,

(ii) provided or commissioned by the Local Health Board, or

(iii) available locally or nationally.

(2) The contractor must self-declare quarterly that the requirements in sub-paragraph (1) have been met and if requested be prepared to provide the evidence to the Local Health Board as required.

Attendance at practice premises

5

(1) The contractor must take steps to ensure that any patient who—

(a) has not previously made an appointment, and

(b) attends at the practice premises for unified services between 8.30am and 6.00pm on a working day,

is provided with such services by an appropriate health care professional on that day.

(2) Sub-paragraph (1) does not apply where—

(a) it is more appropriate for the patient to be referred elsewhere for services under the Act, or

(b) the patient is then offered an appointment to attend again within a time which is appropriate and reasonable having regard to all the circumstances and the patient’s health would not thereby be jeopardised.

Attendance outside practice premises

6

(1) Where the medical condition of a patient is such that, in the reasonable opinion of the contractor—

(a) attendance on the patient is required, and

(b) it would be inappropriate for the patient to attend at the practice premises,

the contractor must provide services to that patient at whichever of the places described in sub-paragraph (2) is in the contractor’s judgement the most appropriate.

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

(a) the place recorded in the patient’s medical records as being the patient’s last home address,

(b) such other place as the contractor has informed the patient and the Local Health Board is the place where the contractor has agreed to visit and treat the patient, or

(3) Nothing in this paragraph prevents the contractor from—

(a) arranging for the referral of the patient without first seeing the patient, in any case where the patient’s medical condition makes that course of action appropriate, or

(b) visiting the patient in circumstances where this paragraph does not place the contractor under an obligation to do so.

Newly registered patients

7

(1) Where a patient has been—

(a) accepted on a contractor’s list of patients, or

(b) assigned to that list by the Local Health Board,

the contractor must invite the patient to participate in a consultation either at the contractor’s practice premises or, if the patient’s medical condition so warrants, at one of the places referred to in paragraph 6(2).

(2) An invitation under sub-paragraph (1) must be issued by the contractor before the end of the period of 6 months beginning with the date of the acceptance of the patient on, or assignment of the patient to, the contractor’s list of patients.

(3) Where a patient (or, where appropriate, in the case of a patient who is a child, the child’s parent) agrees to participate in a consultation mentioned in sub-paragraph (1) the contractor must during the course of that consultation—

(a) make such inquiries and undertake such examinations as appear to the contractor to be appropriate in all the circumstances, and

(b) for all newly registered patients who have attained the age of 16 years, with the co-operation of the patient, complete the latest version of the national minimum dataset questionnaire issued by the Welsh Ministers in order to secure health screening information.

(4) Nothing in this paragraph affects the contractor’s other obligations under the contract in respect of the patient.

Patients not seen within 3 years

8

(1) This paragraph applies where a registered patient who has attained the age of 16 years but has not attained the age of 75 years—

(a) requests a consultation with the contractor, and

(b) has not attended either a consultation with, or a clinic provided by, the contractor within the period of 3 years prior to the date of the request.

(2) The contractor must—

(a) provide the patient with a consultation, and

(b) during that consultation, make such inquiries and undertake such examinations of the patient as the contractor considers appropriate in all the circumstances.

(3) Nothing in this paragraph affects the contractor’s other obligations under the contract in respect of the patient.

Patients aged 75 years and over

9

(1) Where a registered patient who requests a consultation—

(a) has attained the age of 75 years, and

(b) has not participated in a consultation within the year prior to the date of the request,

the contractor must provide such a consultation during which it must make such inquiries and undertake such examinations as it considers appropriate in all the circumstances.

(2) A consultation under sub-paragraph (1) must take place in the home of the patient where, in the reasonable opinion of the contractor, it would be inappropriate, as a result of the patient’s medical condition, for the patient to attend at the practice premises.

(3) Nothing in this paragraph affects the contractor’s other obligations under the contract in respect of the patient.

Clinical reports

10

(1) Where the contractor provides any clinical services, other than under a private arrangement, to a patient who is not on its list of patients, the contractor must, as soon as reasonably practicable, provide a clinical report relating to the consultation, and any treatment provided to the patient, to the Local Health Board.

(2) The Local Health Board must send any report received under sub-paragraph (1)—

(a) to the person with whom the patient is registered for the provision of unified services or their equivalent, or

(b) if the person referred to in paragraph (a) is not known to it, the Local Health Board in whose area the patient is resident.

Storage of vaccines

11

The contractor must ensure that—

(a) all vaccines are stored in accordance with the manufacturer’s instructions, and

(b) all refrigerators in which vaccines are stored have a maximum/minimum thermometer and that temperature readings are taken on all working days.

Infection control

12

The contractor must ensure that it has appropriate arrangements for infection control and decontamination.

Duty of co-operation in relation to supplementary services

13

(1) Where a contractor does not provide to its registered patients or to persons whom it has accepted as temporary residents a particular supplementary service it must comply with the requirements specified in sub-paragraph (2).

(2) The requirements specified in this sub-paragraph are that the contractor must in core hours—

(a) co-operate, insofar as is reasonable, with any person responsible for the provision of that service or those services, and

(b) comply with any reasonable request for information from such a person or from the Local Health Board relating to the provision of that service or those services.

Duty of co-operation in relation to out of hours services

14

The contractor must—

(a) ensure that any patient who contacts the contractor’s practice premises during the out of hours period is provided with information about how to obtain services during that period,

(b) ensure that the clinical details of all out of hours consultations received from the out of hours provider are reviewed by a clinician within the contractor’s practice on the same working day as those details are received by the practice or, exceptionally, on the next working day,

(c) ensure that any information requests received from the out of hours provider in respect of any out of hours consultations are responded to by a clinician within the contractor’s practice on the same day as those requests are received by the contractor’s practice, or on the next working day,

(d) take all reasonable steps to comply with any systems which the out of hours provider has in place to ensure the rapid, secure and effective transmission of patient data in respect of out of hours consultations, and

(e) agree with the out of hours provider a system for the rapid, secure and effective transmission of information about registered patients who, due to chronic disease or terminal illness, are predicted as more likely to present themselves for treatment during the out of hours period.

Membership of a cluster

15

A contract must contain a term which requires the contractor to be a member of a cluster.

Duty of co-operation: cluster working

16

(1) A contractor must comply with the requirements in sub-paragraph (2) where registered patients or temporary residents are provided with services by the contractor’s cluster.

(2) The requirements specified in this sub-paragraph are that the contractor must—

(a) co-operate, in so far as is reasonable, with any person responsible for the provision of the services,

(b) comply in core hours with any reasonable request for information from such a person or from the Local Health Board relating to the provision of the services,

(c) agree the mandate for the GP Collaborative representative at cluster meetings and take account of feedback from those cluster meetings,

(d) take reasonable steps to provide information to its registered patients about the services, including information on how to access the services and any changes to them, and

(e) ensure engagement in the planning and delivery of local services, as agreed within the cluster action plan, which includes suitable arrangements to enable the sharing of data, where appropriate safeguards are met, to support the delivery of the services and discussion of cluster funding and budgets.

(3) In this paragraph, and in paragraphs 18 and 19, “services” means primary medical services.

Membership of a GP Collaborative

17

(1) A contract must contain a term which has the effect of requiring the contractor to be a member of a GP Collaborative.

(2) A contractor must—

(a) appoint at least 1 health care professional with authority to act on the contractor’s behalf in the dealings between the contractor and the GP Collaborative to which the contractor belongs, and

(b) attend at least 4 meetings of the GP Collaborative to which the contractor belongs in each financial year (unless agreed otherwise in writing by the Local Health Board), or appoint a senior practice clinician, or where appropriate a senior administrator, employed by the practice to attend those meetings and to act on the contractor’s behalf in those meetings.

Contribution to clusters and GP Collaboratives

18

A contractor must—

(a) contribute relevant information, including demand and capacity planning, to the cluster ... Plan via the GP Collaborative, and the contribution must include information on demand and capacity planning,

(b) demonstrate how they have engaged in planning and delivery of local services agreed within the GP Collaborative’s contribution to the cluster plan, including evidence of wide partnership, multi-professional/multi-agency working, and development of integrated services, and

(c) contribute to delivering specific cluster-determined outcomes, including engagement in planning of local initiatives through engagement with the cluster via the GP Collaborative lead.

Demand and capacity

19

A contractor is required to engage with a GP Collaborative to assist the collaborative in—

(a) undertaking a population needs assessment of its patients,

(b) analysing the current services available to the GP Collaborative population, identifying any gaps in provision,

(d) undertaking a measurement of local health needs as determined by the GP Collaborative, and

(e) providing evidence of the demand and capacity assessment undertaken which is to be evidenced in the Cluster Plan.

Cessation of service provision: information requests

20

Where a contractor ceases to provide a supplementary service to its patients the contractor must comply with any reasonable request for information relating to the provision of that service, or those services, made by the Local Health Board or by any person with whom the Local Health Board intends to enter into a contract for the provision of such services.

Welsh Language

21

(1) Where the contractor provides medical services under the contract through the medium of Welsh, it must notify the Local Health Board in writing.

(2) The contractor must make available a Welsh language version of any document or form for use by patients and/or members of the public, provided by the Local Health Board.

(3) Where the contractor displays a new sign or notice in connection with medical services provided under the contract, the text on the sign or notice must be in English and Welsh, and the contractor may utilise the translation service offered by the Local Health Board for this purpose.

(4) The contractor must encourage the wearing of a badge, provided by the Local Health Board, by those delivering medical services under the contract who are Welsh speaking, to convey that they are able to speak Welsh.

(5) The contractor must encourage those delivering medical services under the contract to utilise information and/or attend training courses and events provided by the Local Health Board, so that they can develop—

(a) an awareness of the Welsh language (including awareness of its history and its role in Welsh culture), and

(b) an understanding of how the Welsh language can be used when delivering medical services under the contract.

(6) The contractor must encourage those delivering medical services under the contract to establish and record the Welsh or English language preference expressed by or on behalf of a patient.

PART 2 — Patients

List of patients

22

(1) The Local Health Board must prepare and keep up to date a list of the patients who have been—

(a) accepted by the contractor for inclusion in the contractor’s list of patients under paragraphs 22 to 25 and who have not been subsequently removed from that list under paragraphs 28 to 36, and

(b) assigned by the Local Health Board to the contractor’s list of patients under—

(i) paragraph 43(1)(a), or

(ii) paragraph 43(1)(b) (by virtue of a determination of the assessment panel under paragraph 45(7) which has not subsequently been overturned by a determination by the Welsh Ministers under paragraph 46 or by a court).

(2) The contractor must, upon receipt of a reasonable written request from the Local Health Board—

(a) take appropriate steps (including contacting patients where reasonably necessary to confirm that their patient data is correct) as soon as is reasonably practicable, to correct and update patient data held on the practice’s computerised clinical systems, and where necessary register or deregister patients to ensure that the patient list is accurate, and

(b) provide information relating to its list of patients to the Local Health Board as soon as is reasonably practicable and, in any event, no later than 30 days from the date on which the request was received by the contractor, in order to assist the Local Health Board in the exercise of its duties under sub-paragraph (1).

Application for inclusion in a list of patients

23

(1) Unless paragraph 26(1) applies, the contractor must, if the contractor’s list of patients is open, accept an application for inclusion in that list of patients made by or on behalf of any person whether or not resident in its practice area or included, at the time of that application, in the list of patients of another contractor or provider of primary medical services.

(2) If the contractor’s list of patients is closed, the contractor may only accept an application for inclusion in that list made by or on behalf of 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 that application, in the list of patients of another contractor or provider of primary medical services.

(3) Subject to sub-paragraph (4), an application for inclusion in a contractor’s list of patients must be made by the applicant, or a person authorised by the applicant, submitting to the contractor an application form (including an electronic application form). The contractor must not make proof of identification or address a prerequisite for an applicant to be included in the contractor’s list of patients (or make an application conditional upon the production of such proof of identification or address).

(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[^f00057], 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 capacity to make the application, or to authorise the 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 provisions of the Mental Capacity Act 2005[^f00058].

(5) Where a contractor accepts an application for inclusion in the contractor’s list of patients, the contractor must give notice in writing to the Local Health Board of that acceptance as soon as practicable.

(6) The Local Health Board 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) if it is the first time the applicant has been accepted as a registered patient by (or assigned by a Local Health Board to) a contractor or APMS contractor, give notice in writing of that acceptance to the applicant (or, in the case of a child or an adult who lacks capacity, the person making the application on their behalf).

Inclusion in list of patients: armed forces personnel

24

(1) Unless paragraph 26(1) applies, the contractor must, if its list of patients is open, include a person to whom sub-paragraph (2) applies in that list for a period of up to 2 years and paragraph 34(1)(b) does not apply in respect of any 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 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 2 years, or on such earlier date as the contractor’s responsibility for the patient has come to an end, the contractor must—

(a) notify Defence Medical Services in writing that the contractor’s responsibility for the patient 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.

Temporary residents

25

(1) Unless paragraph 26(1) applies, the contractor must, if its list of patients is open, accept a person as a temporary resident if that the person is—

(a) temporarily resident away from their normal place of residence and is not being provided with unified 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 more than 12 weeks.

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

(a) 12 weeks, 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 ceases 7 days after the date on which 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 the Local Health Board of its acceptance of that person as a temporary resident—

(a) at the end of the period of 12 weeks 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 at the end of the 12 week period referred to in paragraph (a), at the end of that period.

Refusal of applications for inclusion in the list of patients or early termination of responsibility for temporary residents

26

(1) The contractor may only refuse an application made under paragraphs 23, 24 or 25 or terminate its responsibility for a person accepted by it as a temporary resident under paragraph 25(3) if it has reasonable grounds for doing so which do not relate to the applicant’s race, social class, age, religion or belief, sexual orientation, appearance, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, disability or medical condition.

(2) The reasonable grounds referred to in sub- paragraph (1) may, in the case of applications made under paragraph 23, include the ground that the applicant does not live in the contractor’s practice area.

(3) Where a contractor refuses an application made under paragraphs 23, 24 or 25 or terminates its responsibility for a person accepted by it as a temporary resident under paragraph 25(3), the contractor must give notice in writing of that refusal or termination and the reasons for it to the applicant (or, in the case of a child or an adult who lacks capacity, to the person who made the application on their behalf) before the end of the period of 14 days beginning with the date of its decision.

(4) The contractor must—

(a) keep a written record of—

(i) the refusal of any application made under paragraphs 23, 24 or 25 or termination its responsibility for a person accepted by it as a temporary resident under paragraph 25(3), and

(ii) the reasons for that refusal or termination, and

(b) make such records available to the Local Health Board on request.

Patient preference of practitioner

27

(1) Where the contractor has accepted an application made under paragraphs 23, 24 or 25 for inclusion in its list of patients, the contractor must record in writing any preference expressed by that person or a person making an application on behalf of that person to receive services from a particular performer, either generally or in relation to a specific condition.

(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

28

(1) The contractor must notify the Local Health Board in writing of any request made by any person who is a registered patient to be removed from the contractor’s list of patients.

(2) Where the Local Health Board—

(a) receives notification from the contractor under sub-paragraph (1), or

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

the Local Health Board 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 sub-paragraph (2) is to take effect on whichever is the earlier of—

(a) the date on which the Local Health Board is given notice of the registration of that person with another provider of unified 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 the Local Health Board.

(4) The Local Health Board 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 29(1)(b) and (10), 30(5) and (6), 32 and 35, a reference to a request received from or advice, information or notice required to be given to, a person must include a request received from or advice, information or notice required to be given to—

(a) in the case of a child—

(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 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 Mental Capacity Act 2005.

Removal from the list at the request of the contractor

29

(1) Subject to paragraph 30, a contractor who has reasonable grounds for wanting a person to be removed from its list of patients which do not relate to the person’s race, social class, age, religion or belief, sexual orientation, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, appearance, disability or medical condition must—

(a) give notice in writing to the Local Health Board that it wants to have the person removed and provide within the notice an explanation of the grounds for the requested removal and why the removal would be reasonable, and

(b) subject to sub-paragraph (2), give notice in writing to the 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 relevant person and the contractor,

the reason given to the patient 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, during the period of 1 year ending with the date of the contractor’s request to the Local Health Board, the contractor has—

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

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

(4) The circumstances referred to in sub-paragraph (3) are that—

(a) the reason for removal relates to a change of address,

(b) the contractor has reasonable grounds for believing that the giving of a warning under sub-paragraph (3)(a) would—

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

(ii) put at risk the safety of one or more of the persons specified in sub-paragraph (5), or

(5) The persons referred to in sub-paragraph (4) are—

(a) the contractor, where the contractor is an individual medical practitioner,

(b) in the case of a contract with two or more persons practising in partnership, a partner in that partnership,

(c) in the case of a contract with a company limited by shares, a person who is both a legal and beneficial owner of shares in that company,

(d) a member of the contractor’s staff,

(e) a person engaged by the contractor to perform or assist in the performance of services under the contract, or

(f) any other person present—

(i) on the practice premises, or

(ii) in the place where services are being provided to the patient under the contract.

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

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

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

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

(a) the reason for removal,

(b) the circumstances of the removal, and

and the contractor must make this record available to the Local Health Board on request.

(8) The removal of a person from the contractor’s list of patients must, subject to sub-paragraph (9), take effect from whichever is the earlier of—

(a) the date on which the Local Health Board is given notice of the registration of that person with another provider of unified services (or their equivalent),

(b) the eighth day after the Local Health Board gives notice to the contractor of its approval of the removal, or

(c) the twenty-eighth day after the date on which the Local Health Board receives the notice from the contractor, if the Local Health Board has neither approved nor rejected the notice during that period.

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

(a) the eighth day after the Local Health Board is given notice by the contractor that the person no longer needs such treatment, or

(b) the date on which the Local Health Board is given notice of the registration of the person with another provider of unified services (or their equivalent).

(10) If a person is to be removed from the contractor’s list of patients pursuant to sub-paragraph (8) or (9), the Local Health Board must give notice in writing to—

(a) the person in respect of whom the removal is approved, 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 (8) or (9).

Removals from the list of patients who are violent

30

(1) Where a contractor wants a person to be removed from its list of patients 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 the Local Health Board in accordance with sub-paragraph (3) requesting that the person be removed from its list of patients.

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

(a) the contractor, where the contractor is an individual medical practitioner,

(b) in the case of a contract with two or more persons practising in partnership, a partner in the partnership,

(c) in the case of a contract with a company limited by shares, a person who is both a legal and beneficial owner of shares in that company,

(d) a member of the contractor’s staff,

(e) a person engaged by the contractor to perform or assist in the performance of services under the contract, or

(f) any other person present—

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

(ii) in the place where services were provided to the person under the contract.

(3) Notification under sub-paragraph (1) must be in writing and include the crime reference number allocated to the incident by the police.

(4) A removal requested in accordance with sub-paragraph (1) takes effect from whichever is the earlier of—

(a) the date on which the Local Health Board is given notice of the registration of that person with another provider of unified services (or their equivalent),

(b) the day after the day on which the Local Health Board gives notice to the contractor of its approval of the removal, or

(c) the seventh day after the date on which the Local Health Board receives the notice from the contractor, if the Local Health Board has neither approved nor rejected the notice within that period.

(5) Where, pursuant to this paragraph, the contractor has given notice to the Local Health Board that it wants to have a patient removed from its list of patients and that request has taken effect under sub-paragraph (4), 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 that person’s physical or mental health, or

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

(6) Where a person is removed from the contractor’s list of patients under this paragraph, the Local Health Board must give that person notice in writing of that removal.

(7) 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 lists if patients registered elsewhere

31

(1) The Local Health Board must remove a person from the contractor’s list of patients if—

(a) the person has subsequently been registered with another provider of unified services (or their equivalent) in the area of the Local Health Board, or

(b) it has received notice from another Local Health Board, NHS England, a Health Board or a Health and Social Care Trust that the patient has subsequently been registered with a provider of unified services (or their equivalent) outside the area of the Local Health Board.

(2) A removal in accordance with sub-paragraph (1) is to take effect—

(a) on the date on which the Local Health Board is given notice of the person’s registration with the new provider, or

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

(3) The Local Health Board 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

32

(1) Subject to sub-paragraph (2), where the Local Health Board 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 that contractor’s practice area, the Local Health Board must—

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

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

(c) inform the person that if, after 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 the Local Health Board accordingly, that person is to be removed from the contractor’s list of patients.

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

Removal from the list of patients whose address is unknown

33

Where the address of a person who is on the contractor’s list of patients is no longer known to the Local Health Board and the Local Health Board reasonably believes this is not due to the patient being unable to provide proof of their address the Local Health Board may—

(a) give notice in writing to the contractor that it intends, at the end of the period of 6 months beginning with the date on which the 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 the Local Health Board that the person is a patient to whom it is still responsible for providing unified services.

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

34

(1) The Local Health Board must remove a person from a contractor’s list of patients where it receives notice to the effect that the person—

(a) intends to be away from the United Kingdom for a period of at least 12 weeks,

(b) is in the armed forces of the Crown (except in the case of a patient to which paragraph 24 applies),

(c) is serving a term of imprisonment of more than 2 years or more than one term of imprisonment totalling, in the aggregate more than 2 years,

(d) has been absent from the United Kingdom for a period of more than 12 weeks, 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, whichever is the latest of—

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

(ii) the date on which the Local Health Board first receives notice of the person’s departure, enlistment or imprisonment, or

(b) where sub-paragraph (1)(d) and (e) applies, the date on which the Local Health Board is given notice of the person’s absence or death.

(3) The Local Health Board must give notice in writing to the contractor of the removal of any person from the contractor’s list of patients under this paragraph.

Removal from the list of patients accepted elsewhere as temporary residents

35

(1) The Local Health Board must remove a person from the contractor’s list of patients where the person has been accepted as a temporary resident by another contractor or other provider of unified services (or their equivalent) where the Local Health Board is satisfied, after due inquiry that—

(a) the person’s stay in the place of temporary residence has exceeded 12 weeks, 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) The Local Health Board must give notice in writing of the removal of a person from a contractor’s list of patients under this paragraph—

(a) to the contractor, and

(b) where practicable, to that person.

(3) A notice given under sub-paragraph (2)(b) must inform the person of—

(a) that person’s entitlement to make arrangements for the provision to that person of unified 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 the Local Health Board.

Removal from the list of pupils etc. of a school

36

(1) Where the contractor provides unified services under the contract to persons on the grounds that they are pupils at, or staff or residents of, a school, the Local Health Board must remove any 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 the Local Health Board has requested a school to provide the particulars referred to in sub-paragraph (1) and has not received those particulars, the Local Health Board 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) The Local Health Board 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

37

(1) Where the contractor has—

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

(i) from a person who is not included (and who is not applying to be 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 sub-paragraph (i) or (ii), by a person specified in paragraph 23(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, or

(b) it comes to the contractor’s attention that the person—

(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) The contractor must keep a written record of terminations under this paragraph and of the reasons for those terminations and must make this record available to the Local Health Board on request.

PART 3 — List of patients: closure, etc.

Application for closure of list of patients

38

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

(2) The application must include the following information—

(a) the period of time, being a period of not less than 12 weeks and not more than 1 year, during which the contractor proposes its list of patients is to be closed,

(b) the current number of the contractor’s registered patients,

(c) the number of registered patients (lower than the current number of such patients, and expressed either in absolute terms or as a percentage of the number of such patients specified pursuant to paragraph (b)) which, if that number were reached, would trigger the re-opening of the contractor’s list of patients,

(d) the number of registered patients (expressed either in absolute terms or as a percentage of the number of such patients specified pursuant to paragraph (b)) which, if that number were reached, would trigger the re-closure of the contractor’s list of patients,

(e) any withdrawal from or reduction in provision of any supplementary services which had previously been provided under the contract, and

(f) any other information which the contractor considers ought to be drawn to the attention of the Local Health Board.

(3) The Local Health Board must acknowledge receipt of the application before the end of the period of 7 days beginning with the date on which the Local Health Board received the application.

(4) The Local Health Board must consider the application and may request such information from the contractor as the Local Health Board requires in order to enable it to determine the application.

(5) The Local Health Board must enter into discussions with the contractor concerning—

(a) the support which the Local Health Board may give to the contractor, or

(b) any changes which the Local Health Board or the contractor may make,

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

(6) The Local Health Board 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) The Local Health Board or the contractor may, at any stage during the discussions, invite the Local Medical Committee (if there is one) for the area in which the contractor provides services under the contract to attend any meetings arranged between the Local Health Board and the contractor to discuss the application.

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

(9) The Local Health Board must enable the contractor to consider and comment on all the information before the Local Health Board makes a decision in respect of the application.

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

(11) The Local Health Board must, before the end of the period of 21 days beginning with the date on which the application was received by the Local Health Board (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, or

(b) reject the application.

(12) The Local Health Board must give notice in writing to the contractor of its decision to—

(a) approve the application in accordance with paragraph 39, or

(b) reject the application in accordance with paragraph 40.

(13) A contractor may not submit more than one application to close its list of patients in any period of 1 year beginning with the date on which the Local Health Board makes its decision on the application unless—

(a) paragraph 40(3) applies, or

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

Approval of an application to close a list of patients

39

(1) Where the Local Health Board approves an application to close a contractor’s list of patients, the Local Health Board 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 the Local Health Board 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 contract, and

(ii) any person who the Local Health Board consulted in accordance with paragraph 38(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 the Local Health Board 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 12 weeks and not more than 1 year,

(b) the date on which the closure of the list of patients is to take effect (“the closure date”), and

(3) Subject to paragraph 41, 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

40

(1) Where the Local Health Board rejects an application to close a contractor’s list of patients it must—

(a) give notice in writing to the contractor of its decision as soon as possible, including the Local Health Board’s 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—

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

(ii) any person who the Local Health Board consulted in accordance with paragraph 38(8).

(2) Subject to sub-paragraph (3), if the Local Health Board rejects an application from a contractor to close its list of patients, the contractor must not make a further application to close its list of patients until whichever is the later of—

(a) the end of the period of 12 weeks beginning with the date on which the Local Health Board’s decision to reject the application was made, or

(b) in a case where a dispute arising from the Local Health Board’s decision to reject the application has been referred to the NHS dispute resolution procedure, the end of the period of 12 weeks 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 contract.

Re-opening of list of patients

41

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

PART 4 — Assignment of patients to lists

42

(1) This Part applies in respect of the assignment by the Local Health Board 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 patients of a contractor within the area of the Local Health Board in which that person resides, or

(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 within the area of the Local Health Board in which that person resides; or

(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 the Local Health Board 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 the Local Health Board 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

43

(1) Subject to paragraph 44, the Local Health Board 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 45(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 Welsh Ministers under paragraph 46(13) or (where applicable) by a court, and

(b) the Local Health Board has entered into discussions with the contractor in question regarding the assignment of new patients if such discussions are required under paragraph 47.

Factors relevant to assignments

44

When assigning a person as a new patient to a contractor’s list of patients under paragraph 43(1)(a) or (b), the Local Health Board 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 6 months beginning with the date on which the application for assignment is received by the Local Health Board,

(d) whether, during the preceding period of 6 months beginning with the date on which the application for assignment is received by the Local Health Board, the person has been removed from a list of patients on the grounds referred to in—

(i) paragraph 29 (relating to the circumstances in which a person may be removed from a contractor’s list of patients at the request of the contractor),

(ii) paragraph 30 (relating to the removal from the contractor’s list of patients of persons who are violent), or

(iii) the equivalent provisions to those paragraphs in relation to arrangements made under section 41(2) of the Act (which relate to arrangements for the provision of primary medical services),

(e) in a case to which sub-paragraph (d)(ii) applies (or 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 the Local Health Board considers relevant.

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

45

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

(2) The Local Health Board must give notice in writing that it has referred the matter to the assessment panel to—

(a) contractors, including those contractors who provide primary medical services under arrangements made under section 41(2) of the Act (which relate to arrangements for the provision of primary medical services) which—

(i) have closed their lists of patients, and

(ii) may, in the opinion of the Local Health Board, be affected by the determination of the assessment panel, and

(b) the Local Medical Committee (if any) for the area in which the contractors referred to in paragraph (a) provide unified services (or their equivalent).

(3) The Local Health Board must ensure that the assessment panel is appointed to consider and determine the proposal made under sub-paragraph (1), and the composition of the assessment panel must be as described in sub-paragraph (4).

(4) The members of the assessment panel must be—

(a) the Chief Executive of the Local Health Board of which the assessment panel is a committee or sub-committee,

(b) a person representative of patients in an area other than that of the Local Health Board which is a party to the contract, and

(c) a person representative of a Local Medical Committee which does not represent practitioners in the area of the Local Health Board which is a party to the contract.

(5) In reaching its determination, the assessment panel must have regard to all relevant factors including—

(a) whether the Local Health Board has attempted to secure the provision of unified services (or their equivalent) for new patients other than by means of assignment to a contractor with a closed list; and

(b) the workload of those contractors likely to be affected by any decision to assign such patients to their list of patients.

(6) The assessment panel must reach a determination before the end of the period of 28 days beginning with the date on which the panel was appointed.

(7) The assessment panel must—

(a) determine whether the Local Health Board may assign new patients to a contractor which has a closed list of patients, and

(b) if it determines that the Local Health Board may make such an assignment, determine, where there is more than one contractor, the contractors to which patients may be assigned.

(8) The assessment panel may determine that the Local Health Board may assign new patients to contractors other than any of the contractors specified in its proposals under sub-paragraph (1), as long as the contractors were given notice in writing under sub-paragraph (2)(a).

(9) The assessment panel’s determination must include its comments on the matters referred to in sub-paragraph (5), and notice in writing of that determination must be given to those contractors referred to in sub-paragraph (2)(a).

Assignment to closed lists: NHS dispute resolution procedure relating to determinations of the assessment panel

46

(1) Where an assessment panel makes a determination under paragraph 45(7) that the Local Health Board may assign new patients to contractors who have closed their lists of patients, any contractor specified in the determination may refer the matter to the Welsh Ministers to review that determination.

(2) Where a matter is referred to the Welsh Ministers under sub-paragraph (1), it must be reviewed in accordance with the procedure specified in the following sub-paragraphs.

(3) Where more than one contractor specified in the determination would like to refer the matter for dispute resolution, those contractors may, if they all agree, refer the matter jointly and, in that case, the Welsh Ministers must review the matter in relation to those contractors together.

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