The Health Services (Pilot Schemes: Miscellaneous Provisions and Consequential Amendments) Regulations (Northern Ireland) 1999

Amendment of the General Medical Services Regulations (Northern Ireland) 1997

4.—(1) The General Medical Services Regulations (Northern Ireland) 1997(1), shall be amended in accordance with the following provisions of this Part of these Regulations.

(2) In regulation 2 (interpretation)—

(a) at the appropriate place in alphabetical order, insert—

““the 1997 Order” means the Health Services (Primary Care) (Northern Ireland) Order 1997;”;

““the Choice of Medical Practitioner Regulations” means the Health Services (Choice of Medical Practitioner) Regulations (Northern Ireland) 1998;”;

• ““personal medical services” has the meaning assigned to it in Article 3(7) of the 1997 Order;”;

““pilot doctor” means a doctor who performs personal medical services in connection with a pilot scheme;”;

• ““pilot scheme” has the meaning assigned to it in Article 3(1) of the 1997 Order;”;

““pilot scheme agreement” means an agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme;”;

““pilot scheme provider” means a person who provides personal medical services in connection with a pilot scheme;”;

““pooled list” means a single list of the patients of two or more pilot doctors which is held in connection with a pilot scheme;”

““primary medical services” means the services described in Article 15E(5) of the Order(2);”;

(b) in the definition of “medical card” for “general medical services” substitute “primary medical services”; and

(c) in the definition of “temporary resident”, for “regulation 25” substitute “regulation 6 of the Choice of Medical Practitioner Regulations”.

(3) In regulation 4 (medical list), in paragraph (1)(a), after “the Order” insert “or Schedule 1 to the 1997 Order”.

(4) After regulation 5, insert the following regulation—

“Preferential right to be included in medical list

5A.— (1) An application by a doctor (“the applicant”) for inclusion of his name in a medical list by virtue of Schedule 1 to the 1997 Order shall be made by sending to the Board an application in writing, which—

(a) shall make clear that the application is made by virtue of that Schedule; and

(b) shall include the information and undertakings specified in paragraphs 1 to 5, 9, 10 and 12 of Part IIA, and Part IIC, of Schedule 3, and in such other paragraphs of that Schedule as are relevant in the applicant’s case.

(2) Upon granting such an application, the Board shall (subject to paragraph (3)), specify that the applicant’s entry in the medical list is subject to one of the conditions which could have been specified by the Board under regulation 13(1) if the application had been one to which that provision relates.

(3) Where the applicant was subject to one of the conditions set out in sub-paragraphs (a) to (c) of regulation 13(1) when his name was last included in a medical list, the Board may not under paragraph (2) specify (among those three conditions)—

(a) one which is more restrictive than the one which applied to him when his name was last so included; or

(b) one which is less restrictive, unless in the Board’s opinion there are exceptional reasons for doing so, and the Board has consulted the Local Medical Committee.

(4) The Board shall notify the Medical Committee of any successful application under paragraph (1) and of any conditions imposed under paragraph (2).”.

(5) In regulation 8 (filling or dispersal of medical practice vacancies), in paragraph (3), at the beginning insert “Subject to regulation 12A,”.

(6) In regulation 9(2) (application to fill a vacancy), after “subject” insert “to regulation 12A and”.

(7) In regulation 12 (Board’s decision on applications and inclusion in the medical list), in paragraph (1), after “the Board shall” insert “(subject to regulation 12A)”.

(8) After regulation 12, insert the following regulation—

“Practice vacancies where patients are subject to pilot scheme proposals

12A.— (1) Paragraph (2) applies where—

(a) a practice has been declared vacant, or a vacancy has arisen, as mentioned in regulation 8;

(b) the Board receives, or has received, a request under Article 6 of the 1997 Order to prepare proposals for a pilot scheme and is under a duty to comply with that request, or has done so;

(c) in the Board’s opinion those proposals relate, or would relate, to more than half of the patients whom it expects to be on the list of any doctor who would fill the vacancy or succeed to the practice; and

(d) in a case to which regulation 9(2) applies—

(i) the panel has not yet made a recommendation, or

(ii) the panel has made a recommendation, but the Agency has not yet forwarded the name of the recommended applicant to the Board.

(2) In a case referred to in paragraph (1),—

(a) without prejudice to any steps that may already have been taken, a Board shall not grant the application of any applicant pursuant to regulation 12(1); and

(b) the panel shall not begin to consider, or shall not further consider, any application received by them, until such time as one of the events set out in paragraph (3) has occurred.

(3) The events referred to in paragraph (2) are that—

(a) the proposals referred to in paragraph (1)(b) are rejected by the Department pursuant to Article 7(1)(c) of the 1997 Order; or

(b) the proposals are withdrawn before the Department has made its decision under Article 7 of the 1997 Order; or

(c) a pilot scheme implemented as a result of the proposals comes to an end, whether pursuant to a direction of the Department given under Article 10(4) of the 1997 Order, or otherwise.

(4) The Board shall forthwith inform the Agency—

(a) if paragraph (1)(a) to (c) applies;

(b) if the Department approves the proposals in question (whether with or without modification); and

(c) where one of the events referred to in paragraph (3) occurs, of that fact.”.

(9) In regulation 18 (doctors' lists)—

(a) in paragraph (1), for “this Part” substitute “the Choice of Medical Practitioner Regulations”

(b) in paragraph (3), for “regulation 21(7)” substitute “regulation 3(3) of the Choice of Medical Practitioner Regulations”;

(c) for paragraph (6), substitute—

“(6) Any removal of a person from a doctor’s list caused by the transfer of a person to the list of another doctor or to a pooled list, other than a transfer under regulation 3(3) of the Choice of Medical Practitioner Regulations, shall take effect—

(a) from the date on which the Agency receives notification of the acceptance of the person by the last-named doctor or, in the case of a transfer to a pooled list, the pilot scheme provider; or

(b) subject to the consent of the Agency, from such date, being not earlier than the date of that consent, as may be agreed between the doctors or, as the case may be, between the doctor and the pilot scheme provider.”; and

(d) in paragraph (8), for sub-paragraph (b), substitute—

“(b) on receipt of the notification mentioned in sub-paragraph (1) of that paragraph, the Agency shall acknowledge it in writing and give written notice of the removal to the person concerned.”.

(10) Regulations 19 (application for services) and 20 (assignment of persons to doctors) are omitted.

(11) In regulation 21 (change of doctor)—

(a) paragraphs (1) to (3) and (5) to (8) are omitted; and

(b) in paragraph (4), at the end, insert “, or to a pooled list”.

(12) In regulation 24 (temporary provision of services), in paragraph (2), after “ceases to be included in the medical list”, insert “(otherwise than in accordance with Article 13(2) of the 1997 Order, to enable him to perform personal medical services in connection with a pilot scheme to which the Board in whose list he was included is a party)”.

(13) For regulation 25 (temporary residents), substitute—

“Temporary residents

25.— (1) A person who is accepted as a temporary resident by a doctor under regulation 6 of the Choice of Medical Practitioner Regulations or by a pilot scheme provider under a pilot scheme agreement shall not be removed from the list of any doctor providing general medical services in which his name is included, unless the Agency is satisfied, after due enquiry—

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

(b) that he has not returned to his normal place of residence, or any other place within the practice area of the doctor in whose list his name is included.

(2) If the Agency is satisfied as mentioned in paragraph (1), it shall remove the name of the person from the list of the doctor in which it is included and, if practicable, inform the person of that fact and of his entitlement to seek acceptance by any doctor, including the doctor by whom he has been treated as a temporary resident, in the area in which he is living.”.

(14) In regulation 26(12)(a) (child health surveillance list) for “regulation 5(3) or regulation 6”, substitute, “regulation 5(3), regulation 6, or Article 13(2) of the 1997 Order”.

(15) In regulation 28 (obtaining contraceptive services), in paragraph (5), for the words from “ regulation 25(4)” to the end, substitute “regulation 25 shall apply to terminate the provision of contraceptive services by any other doctor under paragraph (1), as if those services were general medical services provided to a person included in the list of that other doctor”.

(16) In regulation 33(1)(a) (removal from the obstetric list), for “regulation 6” substitute “regulation 5(3), regulation 6 or Article 13(2) of the 1997 Order”.

(17) In regulation 34 (obtaining maternity medical services), in paragraph (5), for “regulation 19” substitute “regulation 2 of the Choice of Medical Practitioner Regulations”.

(18) In regulation 35(12)(a) (minor surgery list), for “regulation 6” substitute “regulation 5(3), regulation 6, or Article 13(2) of the 1997 Order”.

(19) In regulation 36 (obtaining minor surgery services), in paragraph (1), for “regulation 19”, in each place where those words occur, substitute “regulation 2(3) of the Choice of Medical Practitioner Regulations”.

(20) Schedule 2 (terms of service for doctors) is amended in accordance with the following provisions of this paragraph—

(a) in paragraph 3 (a doctor’s patients)—

(i) in sub-paragraph (1)—

(aa) in head (d), for “regulation 20”, substitute “regulation 4 of the Choice of Medical Practitioner Regulations”,

(bb) in head (e), for “regulation 20(3)(b)”, substitute “regulation 4(4) of the Choice of Medical Practitioner Regulations”, and

(cc) in head (h), at the end add “(or if, in the case of a pilot doctor, more than one such doctor is under an obligation to give treatment, no such doctor practising from the premises to which the request was made is able to attend and give treatment)”;

(ii) in sub-paragraph (4)(b), for “regulation 25” substitute “ regulation 6 of the Choice of Medical Practitioner Regulations (temporary residents)”;

(iii) in sub-paragraph (5)(b), after “obstetric list” insert “or is a pilot doctor who is named in a pilot scheme agreement as responsible for the performance of maternity medical services”;

(iv) in sub-paragraph (6), for “regulation 20(3)(b)”, in each place where those words occur, substitute “regulation 4(4) of the Choice of Medical Practitioner Regulations”; and

(v) in sub-paragraph (7)(a), omit head (ii) and substitute—

“(ii) personal medical services (other than maternity medical services); or

(iii) in the case of a doctor whose name is included in the obstetric list, maternity medical services; or

(iv) in the case of a pilot doctor who is named in a pilot scheme agreement as responsible for the performance of maternity medical services, those services; or”;

(b) in paragraph 4 (relief from liability to give emergency treatment), for “regulation 20(5)” substitute “regulation 4(8) of the Choice of Medical Practitioner Regulations”;

(c) in paragraph 5(2) (acceptance of patients)—

(i) after “medical list”, insert “(otherwise than in accordance with Article 13(2) of the 1997 Order, to enable him to perform personal medical services in connection with a pilot scheme to which the Board in whose list he was included is a party)”; and

(ii) for “regulation 21”, substitute “regulation 3 of the Choice of Medical Practitioner Regulations”;

(d) in paragraph 6 (acceptance of patients), in sub-paragraph (b), for “regulation 25(1)”, substitute “regulation 6(1) of the Choice of Medical Practitioner Regulations”;

(e) in paragraph 9 (termination of responsibility for patients), in each of paragraphs (1)(a) and (2)(b), after “another doctor”, insert “, or is accepted for inclusion in a pooled list”;

(f) in each of—

(i) paragraph 14(5)(a) (provision of services to patients during and outside normal hours);

(ii) paragraph 16(1) (newly registered patients); and

(iii) paragraph 18(4) (patients aged 75 years and over),

for “regulation 20”, substitute “regulation 4 of the Choice of Medical Practitioner Regulations”;

(g) in paragraph 20 (out of hours arrangements), at the end of sub-paragraph (2), insert “, but that arrangement shall terminate if the doctor with whom it is made ceases to be included in a medical list in accordance with Article 13(2) of the 1997 Order to enable him to perform personal medical services under a pilot scheme”;

(h) in paragraph 23 (obligation to give treatment personally)—

(i) in sub-paragraph (3), after “in the obstetric list” in the second place where those words appear, insert “or is a pilot doctor who is named in a pilot scheme agreement as responsible for the performance of maternity medical services under the pilot scheme”;

(ii) in sub-paragraph (5)(a), after “child health surveillance list”, insert “or is a pilot doctor who is named in a pilot scheme agreement as responsible for the performance of child health surveillance services under the pilot scheme”; and

(iii) in sub-paragraph (6)(a), after “minor surgery list”, insert “or is a pilot doctor who is named in a pilot scheme agreement as responsible for the performance of minor surgery services under the pilot scheme”;

(i) in paragraph 24 (responsibility for acts and omissions of deputies)—

(i) in sub-paragraph (1), for “sub-paragraph (2) or (3)” substitute “sub-paragraph 2, or for which the doctor is not responsible, under sub-paragraph (3)”; and

(ii) after sub-paragraph (3), insert—

“(4) Where, in connection with arrangements under a pilot scheme whereby, outside normal hours, pilot doctors and doctors providing general medical services co-operate in such a way that one doctor will cover for another to secure the performance of personal medical services or, as the case may be, the provision of general medical services for their patients, a pilot doctor acts as a deputy to a doctor whose name is included in the medical list, that doctor is not responsible for the acts or omissions of the pilot doctor.”;

(j) in paragraph 26 (organisations providing deputy doctors)—

(i) for sub-paragraph (1)(a), substitute—

“(a) consists only of—

(i) doctors whose names are included in the list of a Board and who arrange to act as deputies to each other, or

(ii) pilot doctors and doctors whose names are included in the list of a Board who co-operate in such a way that one doctor will cover for another to secure the performance of personal medical services or, as the case may be, the provision of general medical services for their patients; and”;

(ii) for sub-paragraph (2)(a). after paragraph (iii), insert—

“(iv) will not be subject to a declaration under paragraph 4 of Schedule 1 to the 1997 Order that he is not fit to be engaged in any capacity in the provision of general medical services; and”;

(k) in paragraph 27 (employment of assistants and deputies), at the end of sub-paragraph (c), insert—

“; or

(d) who is subject to a declaration under paragraph 4 of Schedule 1 to the 1997 Order that he is not fit to be engaged in any capacity in the provision of general medical services”; and

(l) in paragraph 31 (issue of documents), after “the medical list”, insert “, or a pilot doctor acting as a deputy to a doctor whose name is included in the medical list in connection with arrangements under a pilot scheme whereby, outside normal hours, pilot doctors and doctors providing general medical services co-operate in such a way that one doctor will cover for another to secure the performance of personal medical services or, as the case may be, the provision of general medical services for their patients”.

(21) In Schedule 5 (maternity medical services), in paragraph 3(b), for “regulation 19(2)”, substitute “regulation 2(3) of the Choice of Medical Practitioner Regulations”.

(1)

S.R. 1997 No. 380; as amended by S.R. 1998 No. 9

(2)

Article 15E of the Health and Personal Social Services (Northern Ireland) Order 1972 was inserted by Article 23 of the Health Services (Primary Care) (Northern Ireland) Order 1997