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Health and Social Care (Community Health and Standards) Bill


Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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 169   General dental services: transitional

     (1)    The appropriate authority shall by order make transitional provision in respect

of persons who, immediately before the coming into force of section 168, are

providing services under section 35 of the 1977 Act (general dental services).

     (2)    An order under this section may provide that, in such circumstances as the

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order may prescribe, a Primary Care Trust or Local Health Board must, if any

such person so wishes, enter into a general dental services contract with him;

and the order may make provision as to the terms of any such contract.

     (3)    An order under this section may provide that, in such circumstances as the

order may prescribe, a Primary Care Trust or Local Health Board must, if any

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such person so wishes, enter into a contract with him, containing such terms as

the order may specify, for the provision of dental services.

     (4)    An order under this section may make provision for the resolution of disputes

in relation to any contract entered into, or proposed to be entered into, under

subsection (2) or (3), including provision for the determination of disputes by

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the appropriate authority or a person appointed by the authority.

     (5)    An order under this section may make provision in respect of a period

beginning before the coming into force of the provision (or of section 168),

provided that the provision is not as a whole detrimental to the remuneration

of the persons to whom it relates.

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     (6)    In this section—

                     “appropriate authority” means—

                  (a)                 the Secretary of State, in relation to England; and

                  (b)                 the Assembly, in relation to Wales;

                      “general dental services contract” means a contract under section 28K of

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the 1977 Act (as inserted by section 168(1)).

Primary medical services

 170   Provision of primary medical services

In the 1977 Act, after section 16CB (as inserted by section 167 above) insert—

       “16CC                           Primary medical services

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           (1)           Each Primary Care Trust and Local Health Board must, to the extent

that it considers necessary to meet all reasonable requirements, exercise

its powers so as to provide primary medical services within its area, or

secure their provision within its area.

           (2)           A Primary Care Trust or Local Health Board may (in addition to any

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other power conferred on it)—

                  (a)                 provide primary medical services itself (whether within or

outside its area);

                  (b)                 make such arrangements for their provision (whether within or

outside its area) as it thinks fit, and may in particular make

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contractual arrangements with any person.

           (3)           Each Primary Care Trust and Local Health Board must publish

information about such matters as may be prescribed in relation to the

primary medical services provided under this Part.

 

 

Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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           (4)           A body on which functions are conferred under this section must co-

operate with any other such body in the discharge of their respective

functions relating to the provision of primary medical services under

this Part.

           (5)           Regulations may provide that services of a prescribed description are,

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or are not, to be regarded as primary medical services for the purposes

of this Part.

           (6)           Regulations under this section may in particular describe services by

reference to the manner or circumstances in which they are provided.”

 171   General medical services contracts

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     (1)    In the 1977 Act, after section 28P (as inserted by section 168 above) insert—

“General medical services contracts

       28Q      General medical services contracts: introductory

           (1)           A Primary Care Trust or Local Health Board may enter into a contract

under which primary medical services are provided in accordance with

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the following provisions of this Part.

           (2)           A contract under this section is called in this Act a “general medical

services contract”.

           (3)           Subject to any provision made by or under this Part, a general medical

services contract may make such provision as may be agreed between

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the Primary Care Trust or Local Health Board and the contractor or

contractors in relation to—

                  (a)                 the services to be provided under the contract,

                  (b)                 remuneration under the contract, and

                  (c)                 any other matters.

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           (4)           The services to be provided under a general medical services contract

may include—

                  (a)                 services which are not primary medical services;

                  (b)                 services to be provided outside the area of the Primary Care

Trust or Local Health Board.

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           (5)           In this Part, “contractor”, in relation to a general medical services

contract, means any person entering into the contract with the Primary

Care Trust or Local Health Board.

       28R     Requirement to provide certain primary medical services

           (1)           A general medical services contract must require the contractor or

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contractors to provide, for his or their patients, primary medical

services of such descriptions as may be prescribed.

           (2)           Regulations under subsection (1) may in particular describe services by

reference to the manner or circumstances in which they are provided.

 

 

Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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       28S              Persons eligible to enter into GMS contracts            

           (1)           A Primary Care Trust or Local Health Board may, subject to such

conditions as may be prescribed, enter into a general medical services

contract with—

                  (a)                 a medical practitioner;

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                  (b)                 two or more individuals practising in partnership where the

conditions in subsection (2) are satisfied; or

                  (c)                 a company limited by shares where the conditions in subsection

(3) are satisfied.

           (2)           The conditions referred to in subsection (1)(b) in relation to a

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partnership are that—

                  (a)                 at least one partner is a medical practitioner; and

                  (b)                 any partner who is not a medical practitioner is either—

                        (i)                        an NHS employee;

                        (ii)                       a section 28C employee or a section 17C employee;

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                        (iii)                      a health care professional who is engaged in the

provision of services under this Act; or

                        (iv)                       an individual who is providing services under a general

medical services contract or a general dental services

contract or in accordance with section 28C arrangements

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or arrangements under section 17C of the National

Health Service (Scotland) Act 1978, or has so provided

them within such period as may be prescribed.

           (3)           The conditions referred to in subsection (1)(c) in relation to a company

are that—

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                  (a)                 at least one share in the company is legally and beneficially

owned by a medical practitioner; and

                  (b)                 any share which is not so owned is legally and beneficially

owned by a person referred to in subsection (2)(b)(i) to (iv).

           (4)           Regulations may make provision as to the effect, in relation to a general

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medical services contract entered into by individuals practising in

partnership, of a change in the membership of the partnership.

           (5)           In this section—

                                  “health care professional” has the same meaning as in section 28M

above;

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                                  “NHS employee”, “section 28C employee” and “section 17C

employee” have the same meanings as in section 28D above.

       28T     GMS contracts: payments

           (1)           The appropriate authority may give directions as to payments to be

made under general medical services contracts.

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           (2)           A general medical services contract must require payments to be made

under the contract in accordance with directions for the time being in

force under this section.

           (3)           Without prejudice to the generality of the power under subsection (1),

directions under that subsection may—

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                  (a)                 provide for payments to be made by reference to compliance

with standards or the achievement of levels of performance;

 

 

Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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                  (b)                 provide for payments to be made by reference to—

                        (i)                        any scheme or scale specified in the direction; or

                        (ii)                       a determination made by any person in accordance with

factors specified in the direction;

                  (c)                 provide for the making of payments in respect of individual

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practitioners;

                  (d)                 provide that the whole or any part of a payment is subject to

conditions (and may provide that payments are payable by a

Primary Care Trust or Local Health Board only if it is satisfied

as to certain conditions);

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                  (e)                 make provision having effect from a date before the date of the

direction, provided that, having regard to the direction as a

whole, the provision is not detrimental to the persons to whose

remuneration it relates.

           (4)           Before giving a direction under subsection (1), the appropriate

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authority—

                  (a)                 must consult any body appearing to the authority to be

representative of persons to whose remuneration the direction

would relate, and

                  (b)                 may consult such other persons as the authority thinks

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appropriate.

           (5)           Section 18(1) and (3)(b) apply in relation to directions under this

section.

           (6)           References in this section to payments include fees, allowances,

reimbursements, loans and repayments.

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           (7)           In this section “appropriate authority” means—

                  (a)                 the Secretary of State, in relation to a contract made by a

Primary Care Trust;

                  (b)                 the National Assembly for Wales, in relation to a contract made

by a Local Health Board.

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       28U      GMS contracts: other required terms

           (1)           A general medical services contract must contain such provision as

may be prescribed (in addition to the provision required by the

preceding provisions of this Part).

           (2)           Regulations under subsection (1) may in particular make provision as

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to—

                  (a)                 the manner in which, and standards to which, services are to be

provided;

                  (b)                 the persons who perform services;

                  (c)                 the persons to whom services are to be provided;

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                  (d)                 the right of patients to choose the persons from whom they are

to receive services;

                  (e)                 the variation of contract terms (other than terms required by or

under this Part);

                  (f)                 rights of entry and inspection (including inspection of clinical

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records and other documents);

                  (g)                 the circumstances in which, and the manner in which, the

contract may be terminated;

 

 

Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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                  (h)                 enforcement;

                  (i)                 the adjudication of disputes.

           (3)           Regulations making provision under subsection (2)(c) may make

provision as to the circumstances in which a contractor or contractors—

                  (a)                 must or may accept a person as a patient to whom services are

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provided under the contract; or

                  (b)                 may decline to accept a person as such a patient; or

                  (c)                 may terminate his or their responsibility for a patient.

           (4)           Regulations under subsection (2)(e) may—

                  (a)                 make provision as to the circumstances in which a Primary Care

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Trust or Local Health Board may impose a variation of contract

terms;

                  (b)                 make provision suspending or terminating any duty under the

contract to provide services of a prescribed description.

           (5)           Regulations making provision of the kind described in subsection (4)(b)

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may prescribe services by reference to the manner or circumstances in

which they are provided.

           (6)           A general medical services contract must contain provision requiring

the contractor or contractors to comply with any directions given by the

appropriate authority for the purposes of this section as to the drugs,

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medicines or other substances which may or may not be ordered for

patients in the provision of medical services under the contract.

           (7)           Section 18(1) and (3)(b) apply in relation to directions under subsection

(6).

           (8)           In subsection (6) “appropriate authority” has the same meaning as in

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section 28T above.

       28V       GMS contracts: disputes and enforcement

           (1)           Regulations may make provision for the resolution of disputes as to the

terms of a proposed general medical services contract.

           (2)           Regulations under subsection (1) may make provision—

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                  (a)                 for the referral of the terms of the proposed contract to the

Secretary of State or National Assembly for Wales; and

                  (b)                 for the Secretary of State or Assembly, or a person appointed by

him or it, to determine the terms on which the contract may be

entered into.

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           (3)           Regulations may make provision for a person or persons entering into

a general medical services contract to be regarded as a health service

body for any purposes of section 4 of the National Health Service and

Community Care Act 1990, in circumstances where he or they so elect.

           (4)           Regulations under subsection (3) may include provision as to the

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application of section 4 of that Act in cases where—

                  (a)                 persons practising in partnership elect to become a health

service body; and

                  (b)                 there is a change in the membership of the partnership.

           (5)           Where—

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Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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                  (a)                 by virtue of regulations under subsection (3), subsection (7) of

section 4 of that Act applies in relation to a general medical

services contract, and

                  (b)                 a direction as to payments is made under that subsection in

relation to the contract,

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                         the direction is to be enforceable in a county court (if the court so

orders) as if it were a judgment or order of that court.”

     (2)    Sections 29 to 34A of the 1977 Act (arrangements for general medical services)

shall cease to have effect.

 172   General medical services: transitional

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     (1)    The appropriate authority shall by order make transitional provision in respect

of persons who, immediately before the coming into force of section 171, are

providing services under section 29 of the 1977 Act (general medical services).

     (2)    An order under this section may provide that, in such circumstances as the

order may prescribe, a Primary Care Trust or Local Health Board must, if any

15

such person so wishes, enter into a general medical services contract with him;

and the order may make provision as to the terms of any such contract.

     (3)    An order under this section may provide that, in such circumstances as the

order may prescribe, a Primary Care Trust or Local Health Board must, if any

such person so wishes, enter into a contract with him, containing such terms as

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the order may specify, for the provision of medical services.

     (4)    An order under this section may make provision for the resolution of disputes

in relation to any contract entered into, or proposed to be entered into, under

subsection (2) or (3), including provision for the determination of disputes by

the appropriate authority or a person appointed by the authority.

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     (5)    An order under this section may make provision in respect of a period

beginning before the coming into force of the provision (or of section 171),

provided that the provision is not as a whole detrimental to the remuneration

of the persons to whom it relates.

     (6)    In this section—

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                     “appropriate authority” means—

                  (a)                 the Secretary of State, in relation to England; and

                  (b)                 the Assembly, in relation to Wales;

                    “general medical services contract” means a contract under section 28Q of

the 1977 Act (as inserted by section 171).

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Primary dental and medical services: supplementary

 173   Arrangements under section 28C of the 1977 Act

     (1)    Section 28D of the 1977 Act (persons with whom arrangements under section

28C of that Act may be made) is amended as follows.

     (2)    In subsection (1), for paragraphs (b) and (c) substitute—

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                  “(b)                    a medical practitioner who meets the prescr                    ibed conditions;

                  (ba)                    a dental practitioner who meets the prescribed conditions;

                  (bb)                    a health care professional who meets the prescribed conditions;

 

 

Health and Social Care (Community Health and Standards) Bill
Part 4 — Dental and medical services

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                  (bc)                    an individual who is providing services—

                        (i)                        under a general medical services contract or general

dental services contract;

                        (ii)                       in accordance with section 28C arrangements or section

17C arrangements;

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                                      or has so provided them within such period as may be

prescribed;”.

     (3)    After subsection (1) insert—

           “(1A)              The power under subsection (1) to make an agreement with a person

falling within paragraph (bc) or (d) of that subsection is subject to such

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conditions as may be prescribed.”

     (4)    In subsection (2), after the definition of “the 1978 Act” insert—

                    “health care professional” means a person who is a member of a

profession regulated by a body mentioned (at the time the agreement

in question is made) in section 25(3) of the National Health Service

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Reform and Health Care Professions Act 2002;”.

     (5)    In that subsection, for the definition of “NHS employee” substitute—

                    ““NHS employee” means an individual who, in connection with the

provision of services in the health service in England and Wales,

Scotland or Northern Ireland, is employed by—

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                  (a)                 an NHS trust, an NHS foundation trust or (in Northern Ireland)

a Health and Social Services Trust;

                  (b)                 a Primary Care Trust or Local Health Board;

                  (c)                 an individual who is providing services under a general

medical services contract or a general dental services

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contract;

                  (d)                 a medical practitioner whose name is included in a list kept

under the 1978 Act which is equivalent to a list maintained

under section 28W below;

                  (e)                 a dental practitioner whose name is included in a list prepared

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in accordance with regulations made under section 25(2)(a)

of the 1978 Act;

                  (f)                 a medical practitioner whose name is included in a list kept

under article 56 of the Health and Personal Social Services

(Northern Ireland) Order 1972 (1972 No. 1256 (N.I.14));

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                  (g)                 a dental practitioner whose name is included in a list kept under

article 61 of that Order;”.

     (6)    In the definitions of “section 17C employee” and “section 28C employee”, after

“providing” insert “or performing”.

     (7)    In section 28E of the 1977 Act (regulations), in subsection (3), after paragraph

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(c) insert—

                  “(ca)                    impose conditions (including conditions as to qualifications

and experience) to be satisfied by persons performing services

in accordance with section 28C arrangements;

                  (cb)                    provide for the circumstances in which a person providing

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primary medical services under section 28C arrangements—

                        (i)                        must or may accept a person as a patient to whom such

services are so provided;

 

 

 
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