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

Regulation 32

SCHEDULE 7 OUT OF HOURS SERVICES

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

1.—(1) In this Schedule—

“accredited service provider” has the meaning given to it by regulation 2 of the Out of Hours Regulations;

“Out of Hours Regulations” means the National Health Service (Out of Hours Medical Services) and National Health Service (General Medical Services) Amendment Regulations 2002(1);

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

“transferee doctor” means a person referred to in sub-paragraph (5)(b) 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 sub-paragraph (2).

(2) Subject to the provisions of this Schedule, where a contractor is required to provide out of hours services pursuant to regulation 30 or 31, it may, with the approval of the Primary Care Trust, make an arrangement with one of the persons specified in sub-paragraph (5) as if regulations 1 to 11 of the Out of Hours Regulations, subject to the modifications specified in sub-paragraph (6), were still in force.

(3) Any arrangement made pursuant to sub-paragraph (2) shall cease to have effect on 1st January 2005.

(4) An arrangement made in accordance with sub-paragraph (2) shall, for so long as it continues, or is not suspended under paragraph 7(1), 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.

(5) The persons referred to in sub-paragraph (2) are—

(a) an accredited service provider; or

(b) a person who holds a general medical services contract with the Primary Care Trust which includes the provision of out of hours services.

(6) The modifications referred to in sub-paragraph (2) are—

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

(b) as if the requirements relating to an assessing authority in regulation 4(5) to (8) did not apply in cases where, in the opinion of the accrediting authority, it was appropriate and safe to dispense with them;

(c) as if the reference to a medical practitioner in regulation 11(2)(c) was a reference to a contractor;

(d) as if the reference to section 44 in regulation 11(2)(d) was to section 45A of the Act(2); and

(e) as if the reference to a medical list or supplementary list in paragraph 7 of the Schedule was to a medical performers list and the words “or he is named in an agreement under section 2 of the 1997 Act as a performer of personal medical services” were omitted.

(7) A contractor may make more than one out of hours arrangement and may do so (for example) with different transferee doctors or accredited service providers 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 to any patients of maternity medical services during the out of hours period which the contractor is required to provide pursuant to regulation 30 or 31 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 Primary Care Trust for approval of an out of hours arrangement shall be made in writing and shall state—

(a) the name and address of the accredited service provider or the proposed transferee doctor;

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

(c) how the accredited service provider or 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 accredited service provider or 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 Primary Care Trust shall determine the application before the end of the period of 28 days beginning with the day on which the Primary Care Trust received it.

(3) The Primary Care Trust 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 any arrangement with a person referred to in paragraph 1(5)(b) will be of an equivalent standard to an arrangement with a person referred to in paragraph 1(5)(a);

(e) that in the case of an arrangement with a person referred to in paragraph 1(5)(a), the practice premises are within the geographical area in respect of which approval is given under regulation 5 of the Out of Hours Regulations;

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

(g) 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

(h) 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 Primary Care Trust 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 Primary Care Trust’s notification under sub-paragraph (4) was sent.

Effect of approval of an arrangement with a transferee doctor

3.  Where the Primary Care Trust has approved an out of hours arrangement with a transferee doctor the Primary Care Trust 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 104(1) of Schedule 6 shall not apply.

Review of approval

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.

Suspension of approval

5.—(1) Where the Primary Care Trust suspends its approval of an accredited service provider under regulation 9 of the Out of Hours Regulations or receives notice of suspension of such approval under regulation 11 of those Regulations, it shall forthwith suspend its approval of any out of hours arrangement made by the contractor with that accredited service provider.

(2) A suspension of approval under sub-paragraph (1) shall take effect on the day on which the contractor receives notice of suspension of approval of the accredited service provider under regulation 11 of the Out of Hours Regulations.

Immediate withdrawal of approval other than following review

6.—(1) The Primary Care Trust 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(5)(a), if it withdraws its approval of the accredited service provider under regulation 8 of the Out of Hours Regulations or receives notice of withdrawal of such approval under regulation 11 of those Regulations;

(b) in the case of an arrangement with a person referred to in paragraph 1(5)(b), if the person with whom it is made ceases to hold a general medical services contract with the Primary Care Trust which includes the provision of out of hours services; or

(c) where, without any review having taken place under paragraph 4, it appears to the Primary Care Trust that it is necessary in the interests of the contractor’s patients to withdraw its approval immediately.

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

(3) An immediate withdrawal of approval under sub-paragraph (1) shall take effect—

(a) in the case of a withdrawal under sub-paragraph (1)(a), on the day on which the contractor receives notice of withdrawal of approval of the accredited service provider under Regulation 11 of the Out of Hours regulations; or

(b) in the case of a withdrawal under sub-paragraph (1)(b) or (c), on the day on which the notice referred to in sub-paragraph (2) is received by the contractor.

(4) The Primary Care Trust shall notify the Local Medical Committee (if any) for its area of a withdrawal of approval under sub-paragraph (1)(c).

(5) A contractor which wishes to refer a withdrawal of approval under sub-paragraph (1)(c) 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 (2) was sent.

Suspension or termination of an out of hours arrangement

7.—(1) The contractor shall suspend an arrangement made with an accredited service provider under paragraph 1(2) on receipt of the notice of suspension of approval of that provider under regulation 11 of the Out of Hours Regulations.

(2) 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 Primary Care Trust’s approval of that arrangement under paragraph 4 or 6.

(1)

S.I. 2002/2548 as amended by S.I. 2003/26.

(2)

Section 45A was inserted into the Act by paragraph 23 of Schedule 11 to the 2003 Act.