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4.—(1) Where it appears to the Primary Care Trust that it may no longer be satisfied of any of the matters referred to in paragraphs (a) to (h) of paragraph 2(3), it may give notice to the contractor that it proposes to review its approval of the out of hours arrangement.
(2) On any review under sub-paragraph (1), the Primary Care Trust shall allow the contractor a period of 30 days, beginning with the day on which it sent the notice, within which to make representations in writing to the Primary Care Trust.
(3) After considering any representations made in accordance with sub-paragraph (2), the Primary Care Trust may determine to—
(a)continue its approval;
(b)withdraw its approval following a period of notice; or
(c)if it appears to it that it is necessary in the interests of the contractor’s patients, withdraw its approval immediately.
(4) Except in the case of an immediate withdrawal of approval, the Primary Care Trust shall not withdraw its approval without first consulting the Local Medical Committee (if any) for its area.
(5) Where the Primary Care Trust determines to withdraw its approval immediately, it shall notify the Local Medical Committee (if any) for its area.
(6) The Primary Care Trust shall give notice to the contractor of its determination under sub-paragraph (3).
(7) Where the Primary Care Trust withdraws its approval, whether immediately or on notice, it shall include with the notice a statement in writing of the reasons for its determination.
(8) A contractor which wishes to refer the matter in accordance with the NHS dispute resolution procedure must do so before the end of the period of 30 days beginning with the day on which the Primary Care Trust’s notification under sub-paragraph (6) was sent.
(9) Where the Primary Care Trust determines to withdraw its approval following a period of notice, the withdrawal shall take effect at the end of the period of two months beginning with—
(a)the date on which the notice referred to in sub-paragraph (6) was sent; or
(b)where there has been a dispute which has been referred under the NHS dispute resolution procedure and the dispute is determined in favour of withdrawal, the date on which the contractor receives notice of the determination.
(10) Where the Primary Care Trust determines to withdraw its approval immediately, the withdrawal shall take effect on the day on which the notice referred to in sub-paragraph (6) is received by the contractor.
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