The National Health Service (General Medical Services) Regulations 1992

Doctors' availability to patients

29.—(1) Any doctor whose name is included in a medical list shall—

(a) normally be available at such times and places as shall have been approved by the FHSA or, on appeal, by the Secretary of State in his case, in accordance with the requirements of the following provisions of this paragraph, following an application by the doctor; and

(b) inform his patients about his availability in such manner as the FHSA may require in accordance with sub-paragraph (16).

(2) Subject to sub-paragraphs (3), (4), (5) and (6), the FHSA shall not approve any application submitted by a doctor in relation to the times at which he is to be available unless it is satisfied that—

(a) the times proposed are such that the doctor will normally be available—

(i) in 42 weeks in any period of 12 months,

(ii) for no less than the number of hours in any such week which are specified in the condition imposed or treated as imposed in relation to him under regulation 15, and

(iii) on 5 days in any such week;

(b) the hours for which the doctor will normally be available in any week are to be allocated between the days on which he will normally be available in that week in such a manner as is likely to be convenient to his patients;

(c) where the doctor is a three-quarter-time doctor or a half-time doctor, he is practising in partnership with—

(i) another doctor whose name is included in the medical list and who is himself a full-time doctor, or

(ii) two job-sharing doctors whose names are included in the medical list and whose hours are aggregated for the purpose of head (d) of this sub-paragraph;

(d) where the doctor is a job-sharing doctor—

(i) he is practising in partnership with another doctor whose name is included in the medical list, and

(ii) the hours for which both doctors will normally be available will in aggregate be not less than 26 hours in any week referred to in head (a)(i) of this sub-paragraph.

(3) On any application made pursuant to sub-paragraph (1) by a three-quarter-time doctor or a half-time doctor—

(a) head (a)(iii) of sub-paragraph (2) shall not apply; and

(b) any approval of the application shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from that date on which that doctor ceases to satisfy head (c) of sub-paragraph (2).

(4) On any application made pursuant to sub-paragraph (1) by a job-sharing doctor—

(a) head (a)(iii) of sub-paragraph (2) shall apply so as to require either the job-sharing doctor or the other doctor referred to in sub-paragraph (2)(d) to be normally available on each of the days mentioned in that head; and

(b) any approval of the application shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which the doctor ceases to satisfy sub-paragraph (2)(d).

(5) On any application made pursuant to sub-paragraph (1) by a doctor who is a restricted list principal or a restricted services principal, sub-paragraph (2)(a)(i) and (iii), (c) and (d) shall not apply.

(6) The FHSA may, in relation to the application of any full-time doctor who seeks normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a)(i), excuse the doctor from the requirement of head (a)(iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 30.

(7) In this paragraph and in paragraph 30, “available” means, in relation to a doctor, available to provide general medical services to his patients, and for the purposes of calculating the time at which a doctor is to be regarded as available—

(a) account may be taken of any period when the doctor is attending at his practice premises or at any clinic provided by him for his own patients, and of any time spent making a domiciliary visit; but

(b) no account shall be taken of time spent by the doctor holding himself in readiness to make a domiciliary visit if required by any patient;

and “availability” shall be construed accordingly.

(8) An application by a doctor in relation to any place at which he is to be available shall not be approved by the FHSA unless it is satisfied that—

(a) the place at which the doctor proposes to be available is likely to be convenient to his patients;

(b) the location of that place is in accordance with any condition imposed in his case pursuant to section 33(4)(b) or (5) of the Act (distribution of general medical services).

(9) An application for approval pursuant to sub-paragraph (1) shall be made in writing to the FHSA and shall—

(a) include the information specified in Part I of Schedule 8 to these Regulations; and

(b) where appropriate, also include—

(i) in the case of a doctor to whom sub-paragraph (5) applies, the additional information specified in Part II of that Schedule,

(ii) in the case of a doctor to whom sub-paragraph (6) applies, the additional information specified in Part III of that Schedule.

(10) The FHSA shall determine an application within 28 days of receiving it.

(11) In determining any application, the FHSA shall either—

(a) grant approval;

(b) grant approval subject to such conditions as the FHSA sees fit to impose for the purpose of securing that the doctor is available at such times and places as are convenient to his patients; or

(c) refuse approval.

(12) The FHSA shall notify the doctor in writing of its determination, and, where it refuses an application or grants an application subject to conditions, it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (13).

(13) A doctor may within 30 days of receiving a notification pursuant to sub-paragraph (12) appeal in writing to the Secretary of State against any refusal of approval or against any condition imposed pursuant to sub-paragraph (11).

(14) The Secretary of State may, when determining an appeal, either confirm the determination of the FHSA or substitute his own determination for that of the FHSA.

(15) The Secretary of State shall notify the doctor in writing of his determination and shall in every case include with the notification a written statement of the reasons for the determination.

(16) The FHSA may, as it considers appropriate, require a doctor to inform his patients, by displaying a notice at his practice premises or sending notices to them, about the times and places at which he is available.

(17) A doctor may apply to the FHSA for a variation of the times and places at which, in accordance with a determination under this paragraph (“the earlier determination”), he is required to be normally available, and sub-paragraphs (2) to (15) shall apply to the making and determination (“the subsequent determination”) of an application under this sub-paragraph as if it were the first application by that doctor for the purposes of this paragraph.

(18) Where an application made under sub-paragraph (17) is approved or is approved subject to conditions, for the purposes of sub-paragraphs (1) and (16) the earlier determination mentioned in sub-paragraph (17) shall cease to have effect and the subsequent determination mentioned in that sub-paragraph shall have effect instead—

(a) where the subsequent determination is made by the FHSA and no appeal is made, from the day falling 8 weeks after the date on which the doctor receives notification of that FHSA’s determination.

(b) where the subsequent determination is made on appeal, from the day falling 8 weeks after the date on which the doctor receives notification of the Secretary of State’s determination.

(19) Where it appears to the FHSA that a doctor’s hours of availability are allocated for the purposes of sub-paragraph (2)(b) in a manner which may no longer be convenient to his patients, it may, subject to sub-paragraph (26), review the terms of—

(a) any approval granted under sub-paragraph (11)(a) or (b); or

(b) any direction given under sub-paragraph (21)(a);

by the FHSA or the Secretary of State as to such allocation.

(20) On review under sub-paragraph (19) the FHSA shall—

(a) give notice to the doctor of its proposed re-allocation of his hours of availability; and

(b) allow him 30 days within which to make representations to the FHSA about its proposals.

(21) After considering any representations made in accordance with sub-paragraph (20)(b), the FHSA shall either—

(a) direct the doctor to revise the allocation of his hours of availability in the manner specified in the direction; or

(b) confirm that the existing allocation of the doctor’s hours of availability continues to be convenient to his patients.

(22) The FHSA shall notify the doctor in writing of its determination under sub-paragraph (21), and, where it gives a direction under head (a) of that sub-paragraph, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (23).

(23) A doctor may, within 30 days of receiving notification under sub-paragraph (22), appeal in writing to the Secretary of State against a direction under sub-paragraph (21).

(24) Sub-paragraphs (14) and (15) shall apply to any appeal made under sub-paragraph (23).

(25) A doctor in respect of whom a direction is given under sub-paragraph (21) shall revise the allocation of his hours of availability so as to give effect to the direction—

(a) where the direction is given by the FHSA and no appeal is made, not later than 8 weeks after the date on which he receives notification under sub-paragraph (22); or

(b) where the direction is given or confirmed on appeal, not later than 8 weeks after the date on which he receives notification of the Secretary of State’s decision;

and the allocation of hours as so revised shall be regarded as having been approved for the purposes of sub-paragraphs (1) and (16).

(26) No FHSA shall undertake a review under sub-paragraph (19) on more than one occasion in any period of 2 years.