National Health Service (Scotland) Act 1978

General medical services

19 Arrangements and regulations for general medical services

(1) It shall be the duty of every Health Board, in accordance with regulations, to make as respects their area arrangements with medical practitioners for the provision by them of personal medical services for all persons in the area who wish to take advantage of the arrangements; and the services provided in accordance with the arrangements are in this Act referred to as " general medical services ".

(2) Regulations may make provision for defining the personal medical services to be provided and for securing that the arrangements will be such that all persons availing themselves of those services will receive adequate personal care and attendance; and the regulations shall include provision—

(a) for the preparation and publication of lists of medical practitioners who undertake to provide general medical services;

(b) for securing a right to any person to choose or to change, in accordance with the prescribed procedure, the medical practitioner by whom he is to be attended, subject to the consent of the practitioner who is to give the attendance and to any prescribed limit on the number of patients to be accepted by any practitioner;

(c) for the distribution, among medical practitioners whose names are on the aforesaid lists, of any persons who have indicated a wish to obtain general medical services but who have not made any choice of medical practitioner or have been refused by the practitioner chosen;

(d) for the issue to patients or their personal representatives by medical practitioners providing such services as aforesaid of such certificates as may be prescribed, being certificates reasonably required by them under or for the purposes of any enactment;

(e) for the removal from the list of medical practitioners undertaking to provide general medical services for persons in any area of the name of a medical practitioner in whose case it has been determined in such manner as may be prescribed that he has never provided or has ceased to provide general medical services for persons in that area.

(3) The remuneration to be paid under arrangements under this Part to a practitioner who provides general medical services shall not, except in special circumstances, consist wholly or mainly of a fixed salary which has no reference to the number of patients for whom the practitioner has undertaken to provide such services.

20 Applications to provide general medical services

(1) All applications made in the prescribed manner to a Health Board for inclusion in a list kept by that Board of the names of medical practitioners undertaking to provide general medical services for persons in the Board's area shall be referred by the Board to the Medical Practices Committee and (except as mentioned in subsection (2)) any medical practitioner whose application is granted by that Committee shall be entitled to the inclusion of his name in the list.

(2) That entitlement is subject to—

(a) section 21 (requirement of suitable experience);

(b) section 23 (distribution of general medical services);

(c) section 29 (disqualification of practitioners).

21 Requirement of suitable experience

(1) Where the Secretary of State has made regulations for the purposes of this section, and after a day prescribed as the appointed day for those purposes—

(a) the Medical Practices Committee shall refuse any application under section 20 made after that day if the medical practitioner is not suitably experienced; and

(b) a Health Board shall not arrange under section 19 with a medical practitioner for him to provide general medical services for persons in its area unless the Medical Practices Committee have granted an application by him for the inclusion of his name in the list kept by the Board of medical practitioners undertaking to provide general medical services for persons in that area.

(2) For the purposes of this section a medical practitioner is " suitably experienced " if, but only if, he either—

(a) has acquired the prescribed medical experience, or

(b) is by virtue of regulations made under section 22 exempt from the need to have acquired that experience,

and " medical experience " includes hospital experience in any specialty.

22 Regulations as to section 21

(1) Regulations may for the purposes of section 21 provide—

(a) for prescribing the medical experience needed to satisfy paragraph (a) of section 21(2);

(b) as to the documents which an applicant may or must produce as evidence that he is suitably experienced or has acquired medical experience of any particular kind;

(c) for requiring an applicant who claims to have acquired the prescribed experience to submit particulars of his experience to a prescribed body, and for requiring that body, if satisfied that he has acquired the prescribed experience, to issue him a certificate (a " certificate of prescribed experience ") to that effect;

(d) for enabling an applicant without the prescribed experience who considers that the medical experience which he has acquired is, or ought to be regarded as, equivalent to the prescribed experience to submit particulars of that experience to a prescribed body, and for requiring or enabling that body, if satisfied that the applicant's medical experience is so equivalent, to issue him a certificate (a " certificate of equivalent experience ") to that effect;

(e) for treating an applicant who holds a certificate of equivalent experience as satisfying paragraph (a) of section 21(2);

(f) as to the circumstances or conditions in or subject to which a medical practitioner is exempt from the need to have acquired the prescribed experience;

(g) for conferring on an applicant who is refused a certificate of prescribed experience or a certificate of equivalent experience a right of appeal to a body constituted by the Secretary of State, and for any matter for which it appears to the Secretary of State to be requisite or expedient to provide in consequence of the conferring of that right;

(h) for anything authorised or required by section 21 to be prescribed or otherwise provided for by regulations.

In this section—

• " applicant " means a medical practitioner who has made or proposes to make an application to which paragraph (a) of section 21(1) applies;

• " the prescribed experience " means the medical experience for the time being prescribed for the purposes of paragraph (a) of section 21(2).

(2) Regulations under this section shall be framed so as to allow the prescribed experience to be acquired without undertaking whole-time employment.

(3) Any power under this section to make regulations—

(a) may be exercised so as to make different provision for different areas or different periods of time or in relation to different cases or different circumstances;

(b) includes power to make such incidental or supplemental provision in the regulations as the Secretary of State considers appropriate.

23 Distribution of general medical services

(1) The Medical Practices Committee may refuse any application under section 20 on the ground that the number of medical practitioners undertaking to provide general medical services in the area of the Health Board concerned or in part of that area is already adequate.

(2) If in the opinion of the Medical Practices Committee additional practitioners are required for any area or part, but the number of applications exceeds the number required, the Committee shall select the persons whose applications are to be granted and shall refuse the other applications.

(3) Before selecting any persons under subsection (2) the Medical Practices Committee shall consult the Health Board concerned, and that Board shall consult the area medical committee (if any) for their area before expressing their views on the persons to be selected.

(4) Except as provided in subsections (1) to (3), or as required by section 21, the Medical Practices Committee shall not refuse any application under section 20, but the Committee may grant an application subject to conditions excluding the provision of general medical services by the applicant in such part or parts of the area of the Health Board as the Committee may specify.

(5) A medical practitioner who has made an application under section 20 which has been refused or has been granted subject to such conditions may appeal to the Secretary of State; and the Secretary of State may, on any such appeal, direct the Medical Practices Committee to grant the application either unconditionally or subject to such conditions as the Secretary of State may specify.

This subsection does not apply where an application has been refused under paragraph (a) of section 21(1).

(6) Where the Medical Practices Committee select persons from a number of applicants, the persons selected shall not be included in the list in question during the period for bringing an appeal to the Secretary of State or pending the determination of any such appeal.

(7) If the Secretary of State grants an appeal to which subsection (6) above relates, he may direct either that the application—

(a) shall be granted in addition to those already granted; or

(b) shall be granted instead of such one of those applications as he may specify.

In the latter case, he shall make the other applicant a party to the appeal, and no further appeal shall be brought by that applicant in respect of the application in question.

(8) The Medical Practices Committee shall, in a case where persons have to be selected from a number of applicants, and the Secretary of State shall on an appeal in any such case—

(a) have regard to any desire expressed by any applicant to practise with other medical practitioners already providing general medical services in the area or part of an area concerned and to any desire expressed by such other practitioners to take any applicant into practice with them;

(b) have special regard to such matters in cases where an applicant is related to any other such practitioner.

24 Regulations for Medical Practices Committee

Regulations may make provision for conferring or imposing on the Medical Practices Committee such additional functions in relation to arrangements for the provision of general medical services as may be prescribed; and regulations shall provide—

(a) for requiring Health Boards to make to the Medical Practices Committee, at such times and in such manner as may be prescribed, reports as to—

(i) the number of medical practitioners required to meet the reasonable needs of their areas and the different parts of those areas;

(ii) the occurrence of any vacancies in the lists of medical practitioners kept by them under this Part; and

(iii) the need for filling such vacancies ;

(b) for prescribing the procedure for—

(i) the determination of applications by the Medical Practices Committee;

(ii) the making and determination of appeals to the Secretary of State under section 23 ; and

(iii) requiring Health Boards and applicants to be informed of the decisions of the Committee and the Secretary of State.