17. The Board must prepare and keep up to date a list of the patients—
(a)who have been accepted by the contractor for inclusion in the contractor’s list of patients under paragraph 18 and who have not subsequently been removed from that list under paragraphs 23 to 31; and
(b)who have been assigned by the Board to the contractor’s list of patients—
(i)under paragraph 39(1)(a), or
(ii)under paragraph 39(1)(b) (by virtue of a determination of the assessment panel under paragraph 41(8) which has not subsequently been overturned by a determination of the Secretary of State under paragraph 42 or by a court).
18.—(1) The contractor may, if the contractor’s list of patients is open, accept an application for inclusion in that list made by or on behalf of any person whether or not that person is resident in the contractor’s practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.
(2) If the contractor’s list of patients is closed, the contractor may only accept an application for inclusion in that list made by or on behalf of a person who is an immediate family member of a registered patient whether or not that person is resident in the contractor’s practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.
(3) Subject to sub-paragraph (4), an application for inclusion in a contractor’s list of patients must be made by delivering to the contractor’s practice premises a medical card or an application signed (in either case) by the applicant or a person authorised by the applicant to sign on the applicant’s behalf.
(4) An application may be made—
(a)where the patient is a child, on behalf of the patient by—
(i)either parent, or in the absence of both parents, the guardian or other adult who has care of the child,
(ii)a person duly authorised by a local authority to whose care the child has been committed under the Children Act 1989(1), or
(iii)a person duly authorised by a voluntary organisation by which the child is being accommodated under the provisions of the Children Act 1989; or
(b)where the patient is an adult who lacks capacity to make such an application, or to authorise such an application to be made on their behalf, by—
(i)a relative of that person,
(ii)the primary carer of that person,
(iii)a donee of a lasting power of attorney granted by that person, or
(iv)a deputy appointed for that person by the court under the provisions of the Mental Capacity Act 2005(2).
(5) Where a contractor accepts an application for inclusion in the contractor’s list of patients, the contractor must give notice in writing to the Board of that acceptance as soon as possible.
(6) The Board must, on receipt of a notice given under sub-paragraph (5)—
(a)include the applicant in the contractor’s list of patients from the date on which the notice is received; and
(b)give notice in writing to the applicant (or, in the case of a child or an adult who lacks capacity, the person making the application on their behalf) of that acceptance.
19.—(1) The contractor may, if the contractor’s list of patients is open, include a person to whom sub-paragraph (2) applies in that list for a period of up to two years and paragraph 29(1)(b) does not apply in respect of any person who is included in the contractor’s list of patients by virtue of this paragraph.
(2) This sub-paragraph applies to a person who is—
(a)a serving member of the armed forces of the Crown who has received written authorisation from Defence Medical Service(3) to receive primary medical services from the contractor’s practice; and
(b)living or working within the contractor’s practice area during the period in respect of which that written authorisation is given.
(3) Where the contractor has accepted a person to whom sub-paragraph (2) applies onto its list of patients, the contractor must—
(a)obtain a copy of the patient’s medical record, or a summary of that record, from Defence Medical Services; and
(b)provide regular updates to Defence Medical Services, at such intervals as are agreed with Defence Medical Services, about any care and treatment which the contractor has provided to the patient.
(4) At the end of the period of two years, or on such earlier date as the contractor’s responsibility for the patient has come to an end, the contractor must—
(a)notify Defence Medical Services in writing that its responsibility for the patient has come to an end; and
(b)update the patient’s medical record, or summary of that record, and return it to Defence Medical Services.
20.—(1) The contractor may, if the contractor’s list of patients is open, accept a person as a temporary resident provided the contractor is satisfied that the person is—
(a)temporarily resident away from their normal place of residence and is not being provided with essential services (or their equivalent) under any other arrangement in the locality where that person is temporarily residing; or
(b)moving from place to place and not for the time being resident in any place.
(2) For the purposes of sub-paragraph (1), a person is to be regarded as temporarily resident in a place if, when that person arrives in that place, they intend to stay there for more than 24 hours but not for more than three months.
(3) Where a contractor wants to terminate its responsibility for a person accepted by it as a temporary resident before the end of—
(a)three months; or
(b)such shorter period for which the contractor agreed to accept that person as a temporary resident,
the contractor must give notice of that fact to the person either orally or in writing and the contractor’s responsibility for that person is to cease seven days after the date on which notice is given.
(4) Where the contractor’s responsibility for a person as a temporary resident comes to an end, the contractor must give notice in writing to the Board of its acceptance of that person as a temporary resident—
(a)at the end of the period of three months beginning with the date on which the contractor accepted that person as a temporary resident; or
(b)if the contractor’s responsibility for that person as a temporary resident came to an end earlier than at the end of the three month period referred to in paragraph (a), at the end of that period.
21.—(1) The contractor may only refuse an application made under paragraph 18 or 20 if the contractor has reasonable grounds for doing so which do not relate to the applicant’s age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class.
(2) The reasonable grounds referred to in sub-paragraph (1) may, in the case of an application made under paragraph 18, include the ground that the applicant—
(a)does not live in the contractor’s practice area; or
(b)lives in the outer boundary area (the area referred to in regulation 20(3)).
(3) Where a contractor refuses an application made under paragraph 18 or 20, the contractor must give notice in writing of that refusal and the reasons for it to the applicant (or, in the case of a child or an adult who lacks capacity, to the person who made the application on their behalf) before the end of the period of 14 days beginning with the date of its decision to refuse.
(4) The contractor must—
(a)keep a written record of—
(i)the refusal of any application made under paragraph 18, and
(ii)the reasons for that refusal; and
(b)make such records available to the Board on request.
22.—(1) Where the contractor has accepted an application made under paragraph 18 or 20, the contractor must—
(a)give notice in writing to the person (or, in the case of a child or an adult who lacks capacity, to the person who made the application on the applicant’s behalf) of that person’s right to express a preference to receive services from a particular performer or class of performer either generally or in relation to any particular condition; and
(b)record in writing any such preference expressed by or on behalf of that person.
(2) The contractor must endeavour to comply with any reasonable preference expressed under sub-paragraph (1) but need not do so if the preferred performer—
(a)has reasonable grounds for refusing to provide services to the person who expressed the preference; or
(b)does not routinely perform the service in question within the contractor’s practice.
23.—(1) The contractor must give notice in writing to the Board of a request made by any person who is a registered patient to be removed from the contractor’s list of patients.
(2) Where the Board—
(a)receives a notice given by the contractor under sub-paragraph (1); or
(b)receives directly a request from a person to be removed from the contractor’s list of patients,
the Board must remove that person from the contractor’s list of patients.
(3) The removal of a person from a contractor’s list of patients in accordance with sub-paragraph (2) takes effect on whichever is the earlier of—
(a)the date on which the Board is given notice of the registration of that person with another provider of essential services (or their equivalent); or
(b)14 days after the date on which the notice given under sub-paragraph (1) or the request made under sub-paragraph (2) is received by the Board.
(4) The Board must, as soon as practicable, give notice in writing to—
(a)the person who requested the removal; and
(b)the contractor,
that the person’s name is to be or has been removed from the contractor’s list of patients on the date referred to in sub-paragraph (3).
(5) In this paragraph, and in paragraphs 24(1)(b) and (10), 25(6) and (7), 27 and 30, a reference to a request received from or advice, information or notice required to be given to, a person includes a request received from or advice, information or notice required to be given to—
(a)in the case of a child—
(i)either parent, or in the absence of both parents, the guardian or other adult who has care of the child,
(ii)a person duly authorised by a local authority to whose care the child has been committed under the Children Act 1989(4), or
(iii)a person duly authorised by a voluntary organisation by which the child is being accommodated under the Children Act 1989; or
(b)in the case if adult patient who lacks capacity to make the relevant request or receive the relevant advice, information or notice—
(i)a relative of that person,
(ii)the primary carer of that person,
(iii)a donee of a lasting power of attorney granted by that person, or
(iv)a deputy appointed for that person by the court under the Mental Capacity Act 2005(5).
24.—(1) Subject to paragraph 25, where a contractor has reasonable grounds for wanting a person to be removed from its list of patients which do not relate to the person’s age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class the contractor must—
(a)give notice in writing to the Board that it wants to have that person removed; and
(b)subject to sub-paragraph (2), give notice in writing to that person of its specific reasons for requesting the removal of that person.
(2) Where, in the reasonable opinion of the contractor—
(a)the circumstances of the person’s removal are such that it is not appropriate for a more specific reason to be given; and
(b)there has been an irrevocable breakdown in the relationship between the relevant person and the contractor,
the reason given under sub-paragraph (1) may consist of a statement that there has been such a breakdown.
(3) Except in the circumstances specified in sub-paragraph (4), a contractor may only request the removal of a person from its list of patients under sub-paragraph (1) if, before the end of the period of 12 months beginning with the date of the contractor’s request to the Board, the contractor has—
(a)warned that person of the risk of being removed from that list; and
(b)explained to that person the reasons for this.
(4) The circumstances specified in this sub-paragraph are that—
(a)the reason for the removal relates to a change of address;
(b)the contractor has reasonable grounds for believing that the giving of such a warning would—
(i)be harmful to the person’s physical or mental health, or
(ii)put at risk the safety of one or more of the persons specified in sub-paragraph (5); or
(c)the contractor considers that it is not otherwise reasonable or practical for a warning to be given.
(5) The persons referred to in sub-paragraph (4) are—
(a)the contractor, where the contractor is an individual medical practitioner;
(b)in the case of a contract with two or more persons practising in a partnership, a partner in the partnership;
(c)in the case of a contract with a company limited by shares, a person who is both a legal and beneficial owner of shares in that company;
(d)a member of the contractor’s staff;
(e)a person engaged by the contractor to perform or assist in the performance of services under the contract; or
(f)any other person present—
(i)on the practice premises, or
(ii)in the place where services are being provided to the patient under the contract.
(6) The contractor must keep a written record—
(a)the date of any warning given in accordance with sub-paragraph (3) and the reasons for giving such a warning as explained to the person concerned; or
(b)the reason why no such warning was given.
(7) The contractor must keep a written record of the removal of any person from its list of patients under this paragraph which must include—
(a)the reason given for the removal;
(b)the circumstances of the removal; and
(c)in cases where sub-paragraph (2) applies, the grounds for a more specific reason not being appropriate,
and the contractor must make this record available to the Board on request.
(8) The removal of a person from the contractor’s list of patients must, subject to sub-paragraph (9), take effect from whichever is the earlier of—
(a)the date on which the Board is given notice of the registration of that person with another provider of essential services (or their equivalent); or
(b)the eighth day after the Board is given notice under sub-paragraph (1)(a).
(9) Where, on the date on which the removal of a person would take effect under sub-paragraph (8), the contractor is treating that person at intervals of less than seven days, the contractor must give notice in writing to the Board of that fact and the removal is to take effect on whichever is the earlier of—
(a)the eighth day after the Board is given notice by the contractor that the person no longer needs such treatment; or
(b)the date on which the Board is given notice of the registration of the person with another provider of essential services (or their equivalent).
(10) The Board must give notice in writing to—
(a)the person in respect of whom the removal is requested; and
(b)the contractor,
that the person’s name has been or is to be removed from the contractor’s list of patients on the date referred to in sub-paragraph (8) or (9).
25.—(1) Where a contractor wants a person to be removed from its list of patients with immediate effect on the grounds that—
(a)the person has committed an act of violence against any of the persons specified in sub-paragraph (2) or has behaved in such a way that any of those persons has feared for their safety; and
(b)the contractor has reported the incident to the police,
the contractor must give notice to the Board in accordance with sub-paragraph (3).
(2) The persons specified in this sub-paragraph are—
(a)the contractor, where the contractor is an individual medical practitioner;
(b)in the case of a contract with two or more persons practising in partnership, a partner in the partnership;
(c)in the case of a contract with a company limited by shares, a person who is both a legal and beneficial owner of shares in that company;
(d)a member of the contractor’s staff;
(e)a person engaged by the contractor to perform or assist in the performance of services under the contract; or
(f)any other person present—
(i)on the contractor’s practice premises, or
(ii)in the place where services were provided to the person under the contract.
(3) Notice under sub-paragraph (1) may be given by any means but, if not in writing, must subsequently be confirmed in writing before the end of a period of seven days beginning with the date on which notice was given.
(4) The Board must acknowledge in writing receipt of a request for removal from the contractor under sub-paragraph (1).
(5) A removal requested in accordance with sub-paragraph (1) takes effect at the time at which the contractor—
(a)makes a telephone call to the Board; or
(b)sends or delivers the notice to the Board.
(6) Where, under this paragraph, the contractor has given notice to the Board that it wants to have a person removed from its list of patients, the contractor must inform that person of that fact unless—
(a)it is not reasonably practicable for the contractor to do so; or
(b)the contractor has reasonable grounds for believing that to do so would—
(i)be harmful to that person’s physical or mental health, or
(ii)put the safety of any person specified in sub-paragraph (2) at risk.
(7) Where a person is removed from the contractor’s list of patients under this paragraph, the Board must give that person notice in writing of that removal.
(8) The contractor must record the removal of any person from its list of patients under this paragraph and the circumstances leading to that removal in the medical records of the person removed.
26.—(1) The Board must remove a person from the contractor’s list of patients if—
(a)the person has subsequently been registered with another provider of essential services (or their equivalent) in England; or
(b)the Board has been given notice by a Local Health Board, a Health Board or a Health and Social Services Board that the person has subsequently been registered with a provider of essential services (or their equivalent) outside of England.
(2) A removal in accordance with sub-paragraph (1) takes effect—
(a)on the date on which the Board is given notice of the person’s registration with the new provider; or
(b)with the consent of the Board, on such other date as has been agreed between the contractor and the new provider.
(3) The Board must give notice in writing to the contractor of any person removed from its list of patients under sub-paragraph (1).
27.—(1) Subject to sub-paragraph (2), where the Board is satisfied that a person on the contractor’s list of patients has moved and no longer resides in the contractor’s practice area, the Board must—
(a)inform both the person and the contractor that the contractor is no longer obliged to visit and treat that person;
(b)advise the person in writing to either obtain the contractor’s agreement to that person’s continued inclusion on the contractor’s list of patients or to apply for registration with another provider of essential services (or their equivalent); and
(c)inform the person that if, after the end of the period of 30 days beginning with the date on which the advice mentioned in paragraph (b) was given, that person has not acted in accordance with that advice and informed the Board accordingly, that person will be removed from the contractor’s list of patients.
(2) If, at the end of the period of 30 days mentioned in sub-paragraph (1)(c), the Board has not been informed by the person of the action taken, the Board must remove that person from the contractor’s list of patients and inform that person and the contractor of that removal.
28. Where the address of a person who is on the contractor’s list of patients is no longer known to the Board, the Board must—
(a)give notice in writing to the contractor that it intends, at the end of the period of six months beginning with the date on which the notice was given, to remove the person from the contractor’s list of patients; and
(b)at the end of the period referred to in sub-paragraph (a), remove the person from the contractor’s list of patients unless, before the end of that period, the contractor satisfies the Board that the person is a patient to whom it is still responsible for providing essential services.
29.—(1) The Board must remove a person from a contractor’s list of patients where it receives notice to the effect that the person—
(a)intends to be away from the United Kingdom for a period of at least three months;
(b)is in the armed forces of the Crown (except in the case of a patient to which paragraph 19 applies);
(c)is serving a term of imprisonment of more than two years or more than one term of imprisonment totalling, in the aggregate, more than two years;
(d)has been absent from the United Kingdom for a period of more than three months; or
(e)has died.
(2) The removal of a person from a contractor’s list of patients under this paragraph takes effect from—
(a)where sub-paragraph (1)(a) to (c) applies—
(i)the date of the person’s departure, enlistment or imprisonment, or
(ii)the date on which the Board first receives notice of the person’s departure, enlistment or imprisonment,
whichever is the later; or
(b)where sub-paragraph (1)(d) and (e) applies, the date on which the Board is given notice of the person’s absence or death.
(3) The Board must give notice in writing to the contractor of the removal of any person from the contractor’s list of patients under this paragraph.
30.—(1) The Board must remove a person from a contractor’s list of patients where the person has been accepted as a temporary resident by another contractor or other provider of essential services (or their equivalent) in any case where the Board is satisfied, after due inquiry, that—
(a)the person’s stay in the place of temporary residence has exceeded three months; and
(b)the person has not returned to their normal place of residence or to any other place within the contractor’s practice area.
(2) The Board must give notice in writing of the removal of a person from a contractor’s list of patients under this paragraph—
(a)to the contractor; and
(b)where practicable, to that person.
(3) A notice given under sub-paragraph (2)(b) must inform the person of—
(a)that person’s entitlement to make arrangements for the provision to that person of essential services (or their equivalent), including by the contractor by which that person has been treated as a temporary resident; and
(b)the name, postal and electronic mail address and telephone number of the Board.
31.—(1) Where the contractor provides essential services under the contract to persons on the grounds that they are pupils at, or staff or residents of, a school, the Board must remove any person from a contractor’s list of patients who does not appear on the particulars provided by that school of persons who are pupils at, or staff or residents of, that school.
(2) Where the Board has requested a school to provide the particulars referred to in sub-paragraph (1) and has not received those particulars, the Board must consult the contractor as to whether it should remove from the contractor’s list of patients any persons appearing in that list as pupils at, or staff or residents of, that school.
(3) The Board must give notice in writing to the contractor of the removal of any person from the contractor’s list of patients under this paragraph.
32.—(1) Where the contractor has—
(a)received an application for the provision of medical services other than essential services—
(i)from a person who is not included in the contractor’s list of patients,
(ii)from a person that the contractor has not accepted as a temporary resident, or
(iii)made on behalf of a person referred to in paragraph (i) or (ii) by a person specified in paragraph 18(4); and
(b)accepted the person making the application or on whose behalf the application is made as a patient for the provision of the service in question,
the contractor’s responsibility for that person terminates in the circumstances described in sub-paragraph (2).
(2) The circumstances described in this sub-paragraph are that—
(a)the contractor is informed that the person no longer wishes the contractor to be responsible for the provision of the service in question;
(b)in a case where the contractor has reasonable grounds for terminating its responsibility to provide the service to the person which do not relate to the person’s age, appearance, disability or medical condition, gender or gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sexual orientation or social class, the contractor informs the person that it no longer wants to be responsible for providing that person with the service in question; or
(c)it comes to the contractor’s attention that the person—
(i)no longer resides in the area for which the contractor has agreed to provide the service in question, or
(ii)is no longer included in the list of patients of another contractor to whose registered patients the contractor has agreed to provide that service.
(3) Where a contractor wants to terminate its responsibility for a person under sub-paragraph (2)(b), the contractor must give notice to that person of the termination and the reason for it.
(4) The contractor must keep a written record of terminations under this paragraph and of the reasons for those terminations and must make this record available to the Board on request.
(5) A termination under sub-paragraph (2)(b) takes effect—
(a)where the grounds for termination are those specified in paragraph 25(1), from the date on which the notice is given; or
(b)in any other case, 14 days after the date on which the notice is given.