The National Health Service (Out of Hours Provision of Personal Medical Services and Miscellaneous Amendments) (England) Regulations 2003

PART II AMENDMENT OF OTHER REGULATIONS

Amendment of the National Health Service (General Medical Services) Regulations 1992

7.—(1) The National Health Service (General Medical Services) Regulations 1992(1) are amended as follows.

(2) In paragraph 18A of Schedule 2 (terms of service)—

(a) in sub-paragraph (1)(za), for “and “necessary quality standards” have the meaning given to them” substitute “has the meaning given to it”;

(b) in sub-paragraph (2), after “to transfer” insert “any of his liabilities and”;

(c) in sub-paragraph (2C) for “(2A)(b)” substitute “(2)(b)”;

(d) in sub-paragraph (4), after “regulation 31” insert “, and any separate out of hours arrangements he makes may encompass all or any part of the maternity medical services he provides”;

(e) sub-paragraph (6) is omitted;

(f) in sub-paragraph (9), after paragraph (c) insert the following paragraph—

“(cc) where maternity medical services are to be provided under the out of hours arrangement, that they will be performed by a doctor who has such medical experience and training as are necessary to enable the doctor properly to perform such services;”.

(3) After paragraph 21 of Schedule 2 insert the following paragraph—

“21A.— (1) In this paragraph, “organisation providing deputy doctors” means a person who provides deputies to doctors, and includes a body which—

(a) consists only of—

(i) doctors whose names are included in the list of a Primary Care Trust 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 Primary Care Trust 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

(b) keeps separate accounts in relation to such arrangements.

(2) Before entering into arrangements with an organisation providing deputy doctors for the provision of any deputy, a doctor shall—

(a) obtain the written agreement of the organisation that any doctor it provides to him—

(i) will not be subject to a declaration under section 46(2)(c) of the Act, or under any corresponding provision in force in Scotland or Northern Ireland, that he is not fit to be engaged in any capacity in the provision of general medical services,

(ii) will not be suspended by any direction of the Tribunal, other than in a case falling within section 49B(3) of the Act,

(iii) will (unless he is a trainee general practitioner acting in the place of and under the supervision of a doctor responsible for his training) be suitably experienced within the meaning of section 31 of the Act (other than by virtue of being a restricted services principal) or will have the acquired rights specified in regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994,

(iv) will not be subject to a declaration under paragraph 4(3) of Schedule 1 to the 1997 Act that he is not fit to be engaged in any capacity in the provision of general medical services, and

(v) is on a supplementary medical list, medical list or is named as a performer of personal medical services in a pilot scheme; and

(b) take all reasonable steps to satisfy himself that the service provided by the organisation (including its monitoring arrangements) will be adequate and appropriate having regard in particular to the interests of the doctor’s patients.

(3) A doctor shall notify the Primary Care Trust of any arrangements he makes with an organisation providing deputy doctors.

(4) A doctor shall, from time to time and at any time when there are grounds for doing so, take reasonable steps to satisfy himself that an organisation providing deputy doctors with which he has entered into arrangements for the provision of any deputy—

(a) continues to comply with the agreement referred to in sub-paragraph (2)(a); and

(b) continues to provide a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b).

(5) Subject to sub-paragraph (6), if the Primary Care Trust so requests, a doctor shall furnish it with evidence that such an organisation is continuing—

(a) to comply with the agreement mentioned in sub-paragraph (2)(a); or

(b) to provide a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b) above,

as the case may be.

(6) A Primary Care Trust shall not make a request for evidence under sub-paragraph (5)(b) unless—

(a) it has reasonable grounds for believing that the organisation providing deputy doctors is not providing a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b); and

(b) it has consulted the Local Medical Committee.

(7) Subject to sub-paragraph (8), where as a result of evidence provided under sub-paragraph (5)(b), the Primary Care Trust continues to have reasonable grounds for believing that the organisation providing deputy doctors is not providing a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b), it shall give notice (in this paragraph referred to as a “remedial notice”) to the doctor specifying—

(a) the grounds for its concern;

(b) the remedial action it considers necessary; and

(c) the date before which such action must be taken.

(8) A Primary Care Trust shall not issue a remedial notice under sub-paragraph (7) without first consulting the Local Medical Committee.

(9) Where a Primary Care Trust issues a remedial notice under sub-paragraph (7), it shall also send a copy of that notice to any other doctor who has made arrangements with the same organisation.

(10) Where it appears to a Primary Care Trust that—

(a) an organisation providing deputy doctors with which a doctor has made arrangements for the provision of a deputy—

(i) is not complying with the agreement referred to in sub-paragraph (2)(a), or

(ii) has not taken the action specified in a remedial notice issued under sub-paragraph (7) within the time specified in that notice; or

(b) a doctor’s arrangement with such an organisation is such that the doctor’s patients are at risk,

it may give notice to the doctor requiring him to bring his arrangement with that organisation to an end either immediately or before such date as is stated in the notice.”.

(4) In Schedule 10 (drugs and other substances not to be prescribed for supply under pharmaceutical services), omit the following entries—

• Fabrol Granules

• Fluimucil Granules

• Methylcisteine Tablets 100 mg

• Mucodyne Capsules

• Mucodyne Syrup

• Mucodyne Forte Syrup

• Mucodyne Forte Tablets

• Mucodyne Paediatric Syrup

• Visclair Tablets.

(5) In Schedule 11 (drugs to be prescribed under pharmaceutical services only in certain circumstances)—

(a) omit “Acetylcysteine Granules” in column 1 and the entries in columns 2 and 3 which relate to that entry;

(b) omit “Carbocisteine” in column 1 and the entries in columns 2 and 3 which relate to that entry; and

(c) after “Apomorphine Hydrochloride (Uprima)” in columns 1 and 2, insert in each of those columns “, Tadalafil (Cialis)”.

Amendment of the Out of Hours Regulations

8.  The National Health Service (Out of Hours Medical Services) and National Health Service (General Medical Services) Amendment Regulations 2002 are amended as follows—

(a) in regulation 5(5) (approval), for “At the end” substitute “During or at the end”;

(b) in regulation 10(4) (appeal), for “Primary Care Trust” substitute “accrediting authority”; and

(c) in regulation 11(2)(c) (notification), for “Primary Care Trust” substitute “accrediting authority”.

(1)

S.I. 1992/635; the relevant amending instruments are S.I. 1992/2412, 1993/2421, 1994/2620, 1995/3093, 1996/702, 1997/981, 1998/682, 1999/1627, 2000/1645, 2001/3386 and 3742, and 2002/1768, 2469 and 2548.