The General Medical Services and Personal Medical Services Transitional and Consequential Provisions Order 2004

Investigation of certification (regulation 16 of the Service Committees Regulations)

101.—(1) Where the Secretary of State has—

(a) before the relevant date, or on or after the relevant date in respect of an investigation that took place before the relevant date, received information in relation to an investigation of medical certificates issued under and for the purposes of the Social Security Act 1975(1) by a doctor, but he has not yet determined whether to refer the matter for consideration pursuant to regulation 16(1); or

(b) before the relevant date, pursuant to regulation 16(1), referred a matter to a Local Medical Committee, or to a joint committee of two or more Local Medical Committees and the Local Medical Committee has not yet finally determined the matter pursuant to regulation 16(6),

the Secretary of State may, in a case falling within sub-paragraph (a), refer the matter as if the amendments to regulation 16 had not taken effect and, in relation to both sub-paragraphs, the Local Medical Committee or joint committee of Local Medical Committees shall consider or continue to consider (as the case may be) and determine the matter in accordance with regulation 16, subject to the provisions in this article.

(2) Where, pursuant to paragraph (1), the Local Medical Committee makes a determination pursuant to regulation 16(6), it shall forward its report to the contracting PCT and the Performers List PCT (if any), in addition to the persons specified in regulation 16(6), unless the doctor exercises his right of appeal pursuant to regulation 16.

(3) Where—

(a) a doctor—

(i) has appealed against a finding of a Local Medical Committee made before the relevant date pursuant to regulation 16(7), and within the time limit specified in that paragraph, and that appeal has not been determined before the relevant date, or

(ii) appeals against a finding of a Local Medical Committee on or after the relevant date in respect of a finding of a Local Medical Committee made pursuant to paragraph (1) within the time limit specified in regulation 16(7); or

(b) the Secretary of State—

(i) has referred a finding of a Local Medical Committee made before the relevant date pursuant to regulation 16(10), and that referral has not been determined before the relevant date, or

(ii) referred a finding of a Local Medical Committee on or after the relevant date in respect of a finding of a Local Medical Committee made pursuant to paragraph (1),

that appeal or referral shall be determined in accordance with regulation 16 as if the amendments to that regulation had not taken effect, save that written notification of the determination made by the referee or referees shall be given to the contracting PCT and the Performers List PCT (if any).

(4) The Secretary of State may, on or after the relevant date, determine that, pursuant to regulation 16(12), an amount should be recovered from a doctor, and shall, in determining whether an amount should be recovered, act as if the amendments to regulations 11(3), (4) and (5) and 16 and Schedule 5 had not taken effect.

(5) Where pursuant to regulation 16(12), the Secretary of State has determined that an amount should be recovered from a doctor—

(a) before the relevant date, where that amount has not been fully recovered before the relevant date; or

(b) on or after the relevant date pursuant to this article,

that amount shall be recoverable by the appropriate Primary Care Trust, insofar as it has not already been recovered before the relevant date in respect of an amount falling within sub-paragraph (a), and that amount shall be a debt owed to that Primary Care Trust.

(6) Where the contracting PCT has received notification pursuant to this article of an adverse determination in respect of the doctor pursuant to regulation 16, paragraph (7) shall apply without prejudice to any other right the contracting PCT may have to take action against the relevant contractor pursuant to any term of the general medical services contract or default contract.

(7) Where this paragraph applies, the contracting PCT may, in relation to a relevant contractor, take into account the adverse determination of the Secretary of State if it is considering, pursuant to a term of the general medical services contract that gives effect to paragraph 115(7) of Schedule 6 to the Regulations, or an equivalent term in the default contract, whether the cumulative effect of breaches under that contract is such that to allow the contract to continue would be prejudicial to the efficiency of the services provided under that contract.

(8) The contracting PCT shall not, pursuant to paragraph (7), take into account any notification that relates to a determination that was made more than 6 years prior to the date upon which the contracting PCT is considering the matter pursuant to paragraph (7).

(9) Where a Performers List PCT has received notification of an adverse determination pursuant to regulation 16, it shall consider what (if any) action it should take in respect of that doctor pursuant to its powers under the Performers Lists Regulations.

(1)

1975 c. 14.