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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

91

 

175     

General medical services contracts

(1)   

In the 1977 Act, after section 28P (as inserted by section 172 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

5

under which primary medical services are provided in accordance with

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

10

services contract may make such provision as may be agreed between

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

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(c)   

any other matters.

(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

20

Trust or Local Health Board.

(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

25

(1)   

A general medical services contract must require the contractor or

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.

30

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

40

partnership are that—

(a)   

at least one partner is a medical practitioner; and

(b)   

any partner who is not a medical practitioner is either—

 

 

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

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(i)   

an NHS employee;

(ii)   

a section 28C employee, section 17C employee or Article

15B employee;

(iii)   

a health care professional who is engaged in the

provision of services under this Act; or

5

(iv)   

an individual falling within section 28D(1)(bc) above.

(3)   

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

are that—

(a)   

at least one share in the company is legally and beneficially

owned by a medical practitioner; and

10

(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

medical services contract entered into by individuals practising in

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

15

(5)   

In this section—

   

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

above;

   

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

employee” and “Article 15B employee” have the same

20

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.

(2)   

A general medical services contract must require payments to be made

25

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—

(a)   

provide for payments to be made by reference to compliance

30

with standards or the achievement of levels of performance;

(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;

35

(c)   

provide for the making of payments in respect of individual

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

40

as to certain conditions);

(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.

45

(4)   

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

authority—

 

 

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

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(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

appropriate.

5

(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.

(7)   

In this section “appropriate authority” means—

10

(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.

28U     

   GMS contracts: prescription of drugs etc

15

(1)   

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,

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

patients in the provision of medical services under the contract.

20

(2)   

A direction under this section must, subject to subsection (3), be given

by regulations.

(3)   

A direction under this section may be given by an instrument in writing

where it gives effect to a request made in writing to the authority

making the direction by a person who is a holder of a Community

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marketing authorization or United Kingdom marketing authorisation

in respect of the drug, medicine or other substance to which the request

relates.

(4)   

A direction under this section given by an instrument in writing may

be varied or revoked by a further direction under this section (whether

30

given by an instrument in writing or by regulations).

(5)   

In this section—

   

“appropriate authority” has the same meaning as in section 28T

above;

   

“Community marketing authorization” and “United Kingdom

35

marketing authorisation” have the meanings given by

regulation 1 of the Medicines for Human Use (Marketing

Authorisations Etc.) Regulations 1994 (S.I. 1994/3144).

28V      GMS contracts: other required terms

(1)   

A general medical services contract must contain such provision as

40

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

to—

(a)   

the manner in which, and standards to which, services are to be

45

provided;

 

 

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

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(b)   

the persons who perform services;

(c)   

the persons to whom services are to be provided;

(d)   

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

under this Part);

(e)   

rights of entry and inspection (including inspection of clinical

5

records and other documents);

(f)   

the circumstances in which, and the manner in which, the

contract may be terminated;

(g)   

enforcement;

(h)   

the adjudication of disputes.

10

(3)   

Regulations making provision under subsection (2)(c) must 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

provided under the contract; or

(b)   

may decline to accept a person as such a patient; or

15

(c)   

may terminate his or their responsibility for a patient.

(4)   

Regulations under subsection (2)(d) may—

(a)   

make provision as to the circumstances in which a Primary Care

Trust or Local Health Board may impose a variation of contract

terms;

20

(b)   

make provision as to the suspension or termination of any duty

under the contract to provide services of a prescribed

description.

(5)   

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

may prescribe services by reference to the manner or circumstances in

25

which they are provided.

(6)   

Regulations under subsection (1) must make provision as to the right of

patients to choose the persons from whom they are to receive services.

28W       GMS contracts: disputes and enforcement

(1)   

Regulations may make provision for the resolution of disputes as to the

30

terms of a proposed general medical services contract.

(2)   

Regulations under subsection (1) may make provision—

(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

35

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

entered into.

(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

40

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

(4)   

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

application of section 4 of that Act in cases where—

(a)   

persons practising in partnership elect to become a health

service body; and

45

(b)   

there is a change in the membership of the partnership.

 

 

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

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(5)   

Where—

(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

5

relation to the contract,

   

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.

10

176     

General medical 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 175, 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

15

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

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

20

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

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

25

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 175),

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

of the persons to whom it relates.

30

(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 medical services contract” means a contract under section 28Q of

35

the 1977 Act (as inserted by section 175).

Primary dental and medical services: supplementary

177     

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.

40

(2)   

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

“(b)   

a medical practitioner who meets the prescr ibed conditions;

(ba)   

a dental practitioner who meets the prescribed conditions;

 

 

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

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(bb)   

a health care professional who meets the prescribed conditions;

(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, section

5

17C arrangements or Article 15B arrangements; or

(iii)   

under section 19 or 25 of the 1978 Act or Article 56 or 61

of the Health and Personal Social Services (Northern

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

   

or has so provided them within such period as may be

10

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

conditions as may be prescribed.”

15

(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

Reform and Health Care Professions Act 2002;”.

20

(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—

(a)   

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

25

a Health and Social Services Trust;

(b)   

a Primary Care Trust or Local Health Board;

(c)   

a person who is providing services under a general medical

services contract or a general dental services contract;

(d)   

an individual who is providing services as specified in

30

subsection (1)(bc)(iii) above;”.

(6)   

In the definitions of “section 17C employee” and “section 28C employee”, for

“an individual providing” substitute “a person providing or performing”.

(7)   

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

(c) insert—

35

“(ca)   

impose conditions (including conditions as to qualifications

and experience) to be satisfied by persons performing services

in accordance with section 28C arrangements;”.

(8)   

In that section, after subsection (3) insert—

“(3A)   

The regulations may also require payments to be made under the

40

arrangements in accordance with directions given for the purpose by

the Secretary of State; and section 18(1) and (3)(b) apply in relation to

any such directions.

(3B)   

A direction under subsection (3A) may make provision having effect

from a date before the date of the direction, provided that, having

45

regard to the direction as a whole, the provision is not detrimental to

the persons to whose remuneration it relates.”

 

 

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

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(9)   

In that section, after subsection (3B) (as inserted by subsection (8) above),

insert—

“(3C)   

The regulations may also include provision requiring a Primary Care

Trust or Local Health Board, in prescribed circumstances and subject to

prescribed conditions, to enter into a general medical services contract

5

or general dental services contract on prescribed terms with any person

providing services under section 28C arrangements who so requests.”

(10)   

In that section, after subsection (3C) (as inserted by subsection (9) above)

insert—

“(3D)   

The regulations may also include provision for the resolution of

10

disputes as to the terms of any proposed section 28C arrangements, and

in particular may make provision—

(a)   

for the referral of the terms of the proposed arrangements to the

Secretary of State or National Assembly for Wales; and

(b)   

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

15

him or it, to determine the terms on which the arrangements

may be entered into.”

(11)   

In that section, after subsection (3D) (as inserted by subsection (10) above)

insert—

“(3E)   

The regulations must provide for the circumstances in which a person

20

providing primary medical services under section 28C arrangements—

(a)   

must or may accept a person as a patient to whom such services

are so provided;

(b)   

may decline to accept a person as such a patient;

(c)   

may terminate his responsibility for a patient.

25

(3F)   

The regulations must make provision as to the right of patients to

choose the persons from whom they are to receive services under

section 28C arrangements.”

(12)   

In that Act, sections 28F (choice of medical practitioner), 28G (choice of dental

practitioner) and 28H (immunisation) shall cease to have effect.

30

178     

Abolition of pilot schemes

(1)   

Part 1 of the National Health Service (Primary Care) Act 1997 (c. 46) (power to

make pilot schemes for the provision of personal medical and dental services)

shall cease to have effect.

(2)   

This section extends to England and Wales only.

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179     

Persons performing primary medical and dental services

(1)   

In the 1977 Act, after section 28W (as inserted by section 175 above) insert—

“28X    

Persons performing primary medical and dental services

(1)   

Regulations may provide that a health care professional of a prescribed

description may not perform any primary medical service for which a

40

Primary Care Trust or Local Health Board is responsible unless he is

included in a list maintained under the regulations by a Primary Care

Trust or Local Health Board.

 

 

 
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