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The National Health Service (Primary Medical Services Section 17C Agreements) (Scotland) Regulations 2004

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Regulation 12

SCHEDULE 3AGREEMENTS TO PROVIDE ADDITIONAL SERVICES

Additional services generally

1.  The provider shall–

(a)provide in relation to each additional service, such facilities and equipment as are necessary to enable the provider properly to perform that service;

(b)provide each additional service, within core hours, as is appropriate to meet the reasonable needs of its patients; and

(c)have in place arrangements for its patients to access each additional service throughout the core hours in case of emergency.

Cervical screening

2.  (1)  A provider whose agreement includes the provision of cervical screening services shall–

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

(b)make such records as are referred to in sub-paragraph (3).

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

(a)the provision of any necessary information and advice to assist women identified by the Health Board as recommended nationally for a cervical screening test in making an informed decision as to participation in the NHS Scotland Cervical Screening Programme;

(b)the performance of cervical screening tests on women who have agreed to participate in that Programme;

(c)arranging for women to be informed of the results of the test; and

(d)ensuring that test results are followed up appropriately.

(3) The records referred to in sub-paragraph (1)(b) are an accurate record of the carrying out of a cervical screening test, the result of the test and any clinical follow up requirements.

Contraceptive services

3.  (1)  A provider whose agreement includes the provision of contraceptive services shall make available to all its patients who request such services the services described in sub-paragraph (2).

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

(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 provider has a conscientious objection to emergency contraception, prompt referral to another provider (by any arrangement) 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 provider has a conscientious objection to the termination of pregnancy, prompt referral to another provider(by any arrangement) 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 tests for sexually transmitted infections.

(3) An agreement which includes the provision of contraceptive services must provide that for the purposes of paragraphs 10 to 13 of Schedule 1 drugs includes contraceptive substances and appliances includes contraceptive appliances.

Vaccinations and immunisations

4.  (1)  A provider whose agreement includes the provision of vaccinations and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The provider shall–

(a)offer to provide to patients all vaccinations and immunisations (excluding childhood vaccinations and immunisations) of a type and in the circumstances for which a fee was provided for under the 2003-04 Statement of Fees and Allowances made under regulation 35 (payments) of the National Health Service (General Medical Services) (Scotland) Regulations 1995(1) other than influenza vaccination;

(b)provide appropriate information and advice to patients about such vaccinations and immunisations;

(c)record in the patient’s record kept in accordance with paragraph 33 of Schedule 1 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 33 of Schedule 1–

(i)the patient’s consent to the vaccination or immunisation or the name of the person who gave consent to the vaccination or immunisation and the 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 contraindications to the vaccination or immunisation; and

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

(3) The provider shall ensure that all staff involved in administering vaccines are trained in the recognition and initial treatment of anaphylaxis.

Childhood vaccinations and immunisations

5.  (1)  A provider whose agreement includes the provision of childhood vaccinations and immunisations shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The provider shall–

(a)offer to provide to children all vaccinations and immunisations (excluding childhood vaccinations and immunisations) of a type and in the circumstances for which a fee was provided for under the 2003-04 Statement of Fees and Allowances made under regulation 35 (payments) of the National Health Service (General Medical Services) (Scotland) Regulations 1995;

(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 33 of Schedule 1 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 33 of Schedule 1–

(i)the name of the person who gave consent to the vaccination or immunisation and the 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 contraindications to the vaccination or immunisation; and

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

(3) The provider shall ensure that all staff involved in administering vaccines are trained in the recognition and initial treatment of anaphylaxis.

Child health surveillance

6.  (1)  A provider whose agreement includes the provision of child health surveillance services shall, in respect of any child under the age of 5 for whom the provider has responsibility under the agreement–

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

(b)maintain such records as are specified in sub-paragraph (3).

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

(a)the monitoring–

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

(ii)on any occasion when the child is examined or observed by or on behalf of the provider (whether pursuant to (b) below, or otherwise),

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

(b)the examination of the child at a frequency that has been agreed with the Health Board in accordance with the nationally agreed evidence based programme set out in the fourth edition of “Health for all Children”(2).

(3) The records mentioned in sub-paragraph (1)(b) are an accurate record of–

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

Maternity medical services

7.  (1)  A provider whose agreement includes the provision of maternity medical services shall provide–

(a)to female patients who have been diagnosed as pregnant all necessary maternity medical services throughout the antenatal period;

(b)to female patients and their babies all necessary maternity medical services throughout the postnatal period other than neonatal checks;

(c)all necessary maternity medical services to female patients whose pregnancy has terminated as a result of miscarriage or abortion or, where the provider has a conscientious objection to the termination of pregnancy, prompt referral to another provider (by any arrangement) of primary medical services who does not have such conscientious objections.

(2) In this paragraph–

“antenatal period” means the period from the start of the pregnancy to the onset of labour;

“maternity medical services” means–

(a)

in relation to female patients (other than babies) all primary medical services relating to pregnancy, excluding intra partum care; and

(b)

in relation to babies, any primary medical services necessary in their first 14 days of life;

“postnatal period” means the period starting from the conclusion of delivery of the baby or the patient’s discharge from secondary care services, whichever is the later, and ending on the fourteenth day after birth.

Minor surgery

8.  (1)  A provider whose agreement includes the provision of minor surgery shall comply with the requirements in sub-paragraphs (2) and (3).

(2) The provider shall make available to patients where appropriate–

(a)curettage;

(b)cautery; and

(c)cryocautery of warts, verrucae and other skin lesions.

(3) The provider shall ensure that its record of any treatment provided under this paragraph includes the consent of the patient to that treatment.

(1)

S.I. 1995/416; regulation 35 was amended by S.I. 1998/1600, 1999/749 and S.S.I. 1995/54 and 2002/111.

(2)

David Hall and David Elliman, January 2003, Oxford University Press, ISBN 0-19-85188-X

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