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The National Health Service (General Medical Services Contracts) (Wales) Regulations 2004

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Regulation 31

SCHEDULE 7OUT OF HOURS SERVICES

Temporary arrangements for transfer of obligations and liabilities in relation to certain out of hours services

1.—(1) In this Schedule —

“transferee doctor” means a person with whom an arrangement is made under sub-paragraph (2)

“out of hours arrangement” means an arrangement under sub-paragraph (2);

(2) Subject to the provisions of this Schedule, where a contractor is required to provide out of hours services under regulation 30 or 31 it may, until 31st December 2004, with the approval of the Local Health Board, make an arrangement with a person who holds a general medical services contract with the Local Health Board which includes the provision of out of hours services as if the enactments specified in sub-paragraph (4) subject to the modifications specified in sub-paragraph (5) were still in force.

(3) Subject to paragraph 2(3)(f) an arrangement made in accordance with sub-paragraph (2) shall, for so long as it continues, relieve the contractor of —

(a)its obligations to provide out of hours services pursuant to regulation 30 or 31; and

(b)all liabilities under the contract in respect of those services.

(4) The enactments referred to in sub-paragraph (2) are paragraphs 18A to 18C of Schedule 2 to the National Health Service (General Medical Services) Regulations 1992(1) subject to the modifications in paragraph (5).

(5) The modifications referred to in sub-paragraph (4) are —

(a)as if out of hours period had the meaning given in regulation 2 of these Regulations;

(b)as if a transferee doctor meant a person referred to in sub-paragraph (2) (as modified by this sub-paragraph) who has undertaken to carry out the obligations of a contractor during all or part of the out of hours period in accordance with an out of hours arrangement referred to in that sub-paragraph;

(c)as if the references to a doctor in paragraphs 18A(2) (except in head (b)), (3), (4), (5), (7)(b) to (g), (9)(a), (c) and (d), (10, (11) and (13), 18B(1)(2) and (4) to (7) and 18C were references to a contractor.

(d)as if the references to terms of service in paragraph 18A(2), (7)(b) and (f) were references to a contract;

(e)as if the reference to a doctor included in the medical list in paragraph 18A(2)(b) were replaced with a reference to a person who —

(i)holds a general medical services contract, or

(ii)provides personal medical services under section 28C of the Act;

(f)as if the reference to a doctor ceasing to be included in a medical list in paragraph 18A(2C) was a reference to a person ceasing to hold a general medical services contract or to provide personal medical services;

(g)as if the reference to services to patients with whom the doctor has made an arrangement under regulation 31 in paragraph 18A(4) was a reference to services which the doctor is required to provide under the contract;

(h)as if the words “where his name is included in the list of another Health Authority or Primary Care Trust” were omitted from paragraph 18A(7)(a); and

(i)as if sub-paragraphs (6), (7)(h), (14) and (15) of paragraph 18A were omitted.

(6) An arrangement referred to in sub-paragraph (2) shall terminate if the person with whom it is made ceases to hold a general medical services contract.

(7) A contractor may make more than one out of hours arrangement and may do so (for example) with different transferee doctors and in respect of different patients, different times and different parts of its practice area.

(8) A contractor may retain responsibility for, or make separate out of hours arrangements in respect of, the provision of maternity medical services to any patients under the contract and any separate out of hours arrangements it makes may encompass all or any part of the maternity medical services it provides.

(9) Nothing in this paragraph prevents a contractor from retaining or resuming its obligations in relation to named patients.

Application for approval of an out of hours arrangement

2.—(1) An application to the Local Health Board for approval of an out of hours arrangement shall be made in writing and shall state —

(a)the name and address of the proposed transferee doctor;

(b)the periods during which the contractor’s obligations under the contract are to be transferred;

(c)how the proposed transferee doctor intends to meet the contractor’s obligations during the periods specified under paragraph (b);

(d)the arrangements for the transfer of the contractor’s obligations under the contract to and from the transferee doctor at the beginning and end of the periods specified under paragraph (b);

(e)whether the proposed arrangement includes the contractor’s obligations in respect of maternity medical services; and

(f)how long the proposed arrangements are intended to last and the circumstances in which the contractor’s obligations under the contract during the periods specified under paragraph (b) would revert to it.

(2) The Local Health Board shall determine the application before the end of the period of 28 days beginning with the day on which the Local Health Board received it.

(3) The Local Health Board shall grant approval to a proposed out of hours arrangement if it is satisfied —

(a)having regard to the overall provision of primary medical services provided in the out of hours period in its area, that the arrangement is reasonable and will contribute to the efficient provision of such services in the area;

(b)having regard, in particular, to the interests of the contractor’s patients, that the arrangement is reasonable;

(c)having regard, in particular, to all reasonably foreseeable circumstances that the arrangement is practicable and will work satisfactorily;

(d)that it will be clear to the contractor’s patients how to seek primary medical services during the out of hours period;

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

(f)that if the arrangement comes to an end, the contractor has in place proper arrangements for the immediate resumption of its responsibilities,

and shall not refuse to grant approval without first consulting the Local Medical Committee (if any) for its area.

(4) The Local Health Board shall give notice to the contractor of its determination and, where it refuses an application, it shall send the contractor a statement in writing of the reasons for its determination.

(5) 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 Local Health Board’s notification under sub-paragraph (4) was sent.

Effect of approval

3.  Where the Local Health Board has approved an out of hours arrangement with a transferee doctor the Local health Board and the transferee doctor shall be deemed to have agreed a variation of their contract which has the effect of including in it, from the date on which the out of hours arrangement commences and for so long as that arrangement is not suspended or terminated, the services covered by that arrangement and paragraph 102(1) of Schedule 6 shall not apply.

Review of approval

4.—(1) Where it appears to the Local Health Board that it may no longer be satisfied of any of the matters referred to in paragraphs (a) to (f) 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 Local health Board 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 Local Health Board.

(3) After considering any representations made in accordance with sub-paragraph (2), the Local Health Board 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 Local Health Board shall not withdraw its approval without first consulting the Local Medical Committee (if any) for its area.

(5) Where the Local Health Board determines to withdraw its approval immediately, it shall notify the Local Medical Committee (if any) for its area.

(6) The Local Health Board shall give notice to the contractor of its determination under sub-paragraph (3).

(7) Where the Local Health Board 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 Local Health Board’s notification under sub-paragraph (6) was sent.

(9) Where the Local Health Board 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 Local Health Board 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.

Immediate withdrawal of approval other than following review

5.—(1) The Local Health Board shall withdraw its approval of an out of hours arrangement immediately —

(a)in the case of an arrangement with a person referred to in paragraph 1(2), if the person with whom it is made ceases to hold a general medical services contract with the Local Health Board which includes the provision of out of hours services; or

(b)where, without any review having taken place under paragraph 4, it appears to the Local Health Board that it is necessary in the interests of the contractor’s patients to withdraw its approval immediately,

and the withdrawal shall take effect on the day on which the notice is received by the contractor.

(2) The Local Health Board shall give notice to the contractor of a withdrawal of approval under sub-paragraph (1)(b) and (c) and shall include with the notice a statement in writing of the reasons for its determination.

(3) The Local Health Board shall notify the Local Medical Committee (if any) for its area of a withdrawal of approval under sub-paragraph 1(c).

(4) A contractor which wishes to refer a withdrawal of approval under sub-paragraph (1)(b) 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 Local Health Board’s notification under sub-paragraph (2) was sent.

Suspension or termination of an out of hours arrangement

6.  The contractor shall terminate an out of hours arrangement made under paragraph 1(2) with effect from the date of the taking effect of the withdrawal of the Local Health Board’s approval of that arrangement under paragraph 4 or 5.

(1)

S.I. 1992/635 amended by S.I. 1996/702; S.I. 2002/1896 (W.197).

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