The National Health Service (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1989

regulation 21(a)

SCHEDULE 1AMENDMENTS TO PART I OF SCHEDULE 1 TO THE PRINCIPAL REGULATIONS

(TERMS OF SERVICE FOR DOCTORS)

1.  For paragraph 3 (general) there shall be substituted the following paragraph:–

“3.  Where a decision whether any, and if so what, action is to be taken under these terms of service requires the exercise of professional judgment, a doctor shall not, in reaching that decision, be expected to exercise a higher degree of skill, knowledge and care than–

(a)in the case of a doctor providing child health surveillance services under paragraph 9B or minor surgery services under paragraph 9C, that which any general practitioner included in the child health surveillance list or, as the case may be, the minor surgery list may reasonably be expected to exercise; and

(b)in any other case, that which general practitioners as a class may reasonably be expected to exercise.”.

2.  In paragraph 4 (a doctor’s patients) for the words “under paragraph 8” in sub-paragraph (1)(g), there shall be substituted the words “under paragraph 8, 9B or 9C”.

3.  After paragraph 9 there shall be inserted the following paragraphs–

“Provision of child health surveillance services and minor surgery services

9A.  A doctor whose name is included in the medical list may, in respect of any person on his list or on the list of a doctor with whom he is in partnership or with whom he is associated in a group practice, undertake to provide–

(a)child health surveillance services, provided that–

(i)his name is also included in the child health surveillance list, and

(ii)the person in question is a child who is under the age of 5 years;

(b)minor surgery services, provided that his name is included in the minor surgery list.

9B.  A doctor who has undertaken, pursuant to paragraph 9A(a), to provide child health surveillance services to any child shall, in respect of that child–

(a)provide all the services described in paragraph 1 of Schedule 1A to these Regulations, other than any examination so described which the parent refuses to allow the child to undergo, until the date upon which the child attains the age of 5 years;

(b)maintain such records as are specified in paragraph 2 of that Schedule; and

(c)furnish the relevant health authority with such information as is specified in paragraph 3 of that Schedule in accordance with the requirements of that paragraph.

9C.—(1) A doctor who has undertaken, pursuant to paragraph 9A(b), to provide minor surgery services in respect of any patient shall offer to provide any of the procedures described in Schedule 1B to these Regulations which it is, in his opinion, appropriate for him to provide in the case of that patient.

(2) Where a doctor provides minor surgery services in respect of a patient who is not included on his list, he shall inform in writing the doctor on whose list the patient is included of the outcome of the procedure.”.

4.  After paragraph 12 there shall be inserted the following paragraph:–

“12A.—(1) An undertaking referred to in paragraph 9A(a) shall cease forthwith to be effective if–

(a)either–

(i)the parent informs the doctor, or

(ii)the doctor informs the parent,

that he wishes the undertaking to have no further effect;

(b)the child has been removed from the doctor’s list, from that of his partner or from that of a doctor with whom he is associated in a group practice, as the case may be, and has not been transferred to any other of those lists;

(c)the parent–

(i)has been invited to arrange for the child to attend for an examination referred to in paragraph 1(b) of Schedule 1A to these Regulations, and

(ii)fails within 42 days to respond to that invitation; or

(d)any examination referred to in paragraph 1(b) of that Schedule is undertaken in respect of the child otherwise than by the doctor or a person acting on his behalf.

(2) Where, in accordance with sub-paragraph (1), an undertaking referred to in paragraph 9A(a) has ceased to be effective, the doctor shall forthwith–

(a)in a case to which any of heads (a), (c) or (d) of that sub-paragraph applies, so inform the Committee in writing; and

(b)in a case to which either head (c) or (d) of that sub-paragraph applies, also so inform the parent in writing.”.

5.  For paragraph 13 (service to patients) there shall be substituted the following paragraphs:–

“Nature of service to patients

13.—(1) Subject to paragraphs 3, 13A and 36A, a doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general medical practitioners.

(2) The services which a doctor is required by sub-paragraph (1) to render shall include the following:–

(a)giving advice, where appropriate, to a patient in connection with the patient’s general health, and in particular about the significance of diet, exercise, the use of tobacco, the consumption of alcohol and the misuse of drugs and solvents;

(b)offering to patients consultations and, where appropriate, physical examinations for the purpose of identifying, or reducing the risk of, disease or injury;

(c)offering to patients, where appropriate, vaccination or immunisation against Measles, Mumps, Rubella, Pertussis, Poliomyelitis, Diphtheria and Tetanus;

(d)arranging for the referral of patients, as appropriate, for the provision of any other services under the National Health Service Act 1977(1);

(e)giving advice, as appropriate, to enable patients to avail themselves of services provided by a local social services authority.

(3) A doctor is not required by sub-paragraph (1) or (2)–

(a)to provide to any person contraceptive services, child health surveillance services, minor surgery services nor, except in an emergency, maternity medical services, unless he has previously undertaken to the Committee to provide such services to that person; or

(d)where he is a restricted services principal, to provide any category of general medical services which he has not undertaken to provide.

Provision of service to patients

13A.—(1) The services referred to in paragraph 13 shall be rendered by a doctor–

(a)at his practice premises; or

(b)if the condition of the patient so requires–

(i)at the place where the patient was residing when he was accepted by the doctor pursuant to paragraph 6 or, as the case may be, when he was assigned to the doctor pursuant to regulation 16, or, in the case of a patient who was previously on the list of a doctor in a practice declared vacant, when the doctor succeeded to the vacancy, or

(ii)at such other place as the doctor has informed the patient and the Committee is the place where has agreed to visit and treat the patient if the patient’s condition so requires; or

(iii)in any other case, at some other place in the doctor’s practice area.

(2) Without prejudice to the generality of sub-paragraph (1) a doctor shall in particular make himself available for consultations at such places and at such times as have been approved by the Committee in his case, pursuant to paragraph 25.

Newly registered patients

13B.—(1) Subject to sub-paragraphs (4) to (9), where a patient has been accepted on a doctor’s list under paragraph 6 or assigned to a doctor’s list under regulation 16, the doctor shall, in addition to and without prejudice to his other obligations in respect of that patient under these terms of service, within 28 days of the date of such acceptance or assignment invite the patient to participate in a consultation either at his practice premises or, if the condition of the patient so warrants, at such other place as the doctor is obliged, under paragraph 13A(1)(b), to render personal medical services to that patient.

(2) Where a patient (or, in the case of a patient who is a child, his parent) agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation–

(a)seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of–

(i)illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer,

(ii)social factors (including employment, housing and family circumstances) which may affect his health,

(iii)factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol, and misuse of drugs or solvents) which may affect his health, and

(iv)the current state of his health;

(b)offer to undertake a physical examination of the patient, comprising–

(i)the measurement of his height, weight and blood pressure, and

(ii)the taking of a urine sample and its analysis to identify the presence of albumin and glucose;

(c)record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d)assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient; and

(e)in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient (or, where the patient is a child, the parent) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(3) On each occasion where a doctor invites a patient or parent to participate in a consultation pursuant to sub-paragraph (1) he shall–

(a)make the invitation in writing or, if the invitation is initially made orally, confirm it in writing, by a letter either handed to the patient or his representative or sent to the patient or parent at the address recorded in his medical records as being his last home address;

(b)record in the patient’s medical records the date of each such invitation and whether or not it was accepted;

(c)where, as a result of making the invitation, the doctor becomes aware that the patient is no longer residing at the address shown in his medical records, advise the Committee accordingly.

(4) A doctor shall not be obliged to offer a consultation pursuant to sub-paragraph (1)–

(a)if he is a restricted services principal;

(b)in respect of a child under the age of 5 years;

(c)to any patient who, immediately before joining the list of the doctor, was a patient of a partner of the doctor and who, during the 12 months immediately preceding the date of his acceptance or assignment to the doctor’s list, had participated in a consultation pursuant to sub-paragraph (1); or

(d)to the extent allowed by the Committee, to any patient within a class of patients in respect of which the Committee or, on appeal, the Secretary of State has, pursuant to sub-paragraphs (5) to (8), deferred the doctor’s obligation under sub-paragraph (1).

(5) Where a doctor assumes responsibility for a list of patients on his succession to a practice declared vacant or otherwise becomes responsible for a significant number of new patients within a short period, he may apply, in accordance with sub-paragraph (6), to the Committee for the deferment of his obligation under sub-paragraph (1) for a period not exceeding 2 years from the date of the application.

(6) An application pursuant to sub-paragraph (5) shall be made in writing and shall be accompanied by a statement of the doctor’s proposals, by reference to particular classes of patient, with a view to securing that all eligible patients are invited to participate in a consultation pursuant to sub-paragraph (1) by the end of the period of the deferment.

(7) Within 2 months of receiving an application the Committee shall determine it–

(a)by approving the application;

(b)by approving the application subject to conditions; or

(c)by refusing the application.

(8) A doctor may appeal in writing to the Secretary of State against any refusal of an application, or against any condition subject to which an application is approved by a Committee pursuant to sub-paragraph (7)(b) and on determining such an appeal the Secretary of State shall either confirm the Committee’s determination or substitute his own determination for that of the Committee.

(9) The Secretary of State shall notify the doctor in writing of his determination and shall include with the notice a statement of his reasons for the determination.

Patients not seen within 3 years

13C.—(1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligation under these terms of service, invite each patient on his list who appears to him–

(a)to have attained the age of 16 years but who has not attained the age of 75 years; and

(b)to have neither–

(i)within the preceding 3 years attended either a consultation with, or a clinic provided by, any doctor, nor

(ii)within the preceding 12 months been offered a consultation pursuant to this sub-paragraph by any doctor,

to participate in a consultation at his practice premises for the purpose of assessing whether he needs to render personal medical services to that patient.

(2) Sub-paragraph (1) shall not apply in the case of a doctor who is a restricted services principal.

(3) In the case of any patient who is included on the doctor’s list on 1st April 1990, the first invitation to participate in a consultation pursuant to sub-paragraph (1) shall be made no later than 1st April 1991.

(4) When inviting a patient to participate in a consultation pursuant to sub-paragraph (1) a doctor shall comply with the requirements of paragraph 13B(3).

(5) Where a patient agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation–

(a)where appropriate, seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of–

(i)illnesses, immunisations, allergies, hereditary diseases, medication and tests carried out for breast or cervical cancer,

(ii)social factors (including employment, housing and family circumstances) which may affect his health,

(iii)factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol, and misuse of drugs or solvents) which may affect his health, and

(iv)the current state of his health;

(b)offer to undertake a physical examination of the patient, comprising–

(i)the measurement of his height, weight and blood pressure, and

(ii)the taking of a urine sample and its analysis to identify the presence of albumin and glucose;

(c)record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d)assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient; and

(e)in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

Patients aged 75 years and over

13D.—(1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligations under these terms of service, in each period of 12 months beginning on 1st April in each year–

(a)invite each patient on his list who has attained the age of 75 years to participate in a consultation; and

(b)offer to make a domiciliary visit to each such patient,

for the purpose of assessing whether he needs to render personal medical services to that patient.

(2) Sub-paragraph (1) shall not apply in the case of any doctor who is a restricted services principal.

(3) Any consultation pursuant to sub-paragraph (1) may take place in the course of a domiciliary visit pursuant to that sub-paragraph.

(4) An invitation and an offer pursuant to sub-paragraph (1) shall be made by a doctor–

(a)in the case of a patient who is over the age of 75 years and is on the doctor’s list on 31st March 1990, by no later than 1st April 1991;

(b)in the case of a patient who attains the age of 75 years on or after 1st April 1990, within 12 months of his 75th birthday;

(c)in the case of a patient who–

(i)is accepted by the doctor pursuant to paragraph 6, or assigned to him pursuant to regulation 16, after 1st April 1990, and

(ii)who has attained the age of 75 years when he is so accepted or assigned,

within 12 months of the date of his acceptance or assignment.

(5) A doctor shall, when making an assessment following a consultation under sub-paragraph (1), record in the patient’s medical records the observations made of any matter which appears to him to be affecting the patient’s general health, including where appropriate the patient's–

(a)sensory functions;

(b)mobility;

(c)mental condition;

(d)physical condition including continence;

(e)social environment;

(f)use of medicines.

(6) A doctor shall keep with the patient’s medical records a report of any observations made in the course of a domiciliary visit made pursuant to sub-paragraph (1) which are relevant to the patient’s general health.

(7) When inviting a patient to participate in a consultation, or offering him a domiciliary visit, pursuant to sub-paragraph (1), a doctor shall comply with the requirements of paragraph 13B(3) as if that sub-paragraph referred to an offer as well as an invitation.

(8) Where a patient has participated in a consultation pursuant to sub-paragraph (1), the doctor shall offer to discuss with him the conclusions he has drawn, as a result of the consultation, as to the state of the patient’s health, unless to do so would, in the opinion of the doctor, be likely to cause serious harm to the physical or mental health of the patient.”.

6.  For paragraph 15 (absences) there shall be substituted the following paragraph:–

“Duration of doctor’s responsibility

15.—(1) Subject to paragraph (2), a doctor is responsible for ensuring the provision to his patients of the services referred to in paragraph 13 throughout each day during which his name is included in the Committee’s medical list.

(2) A doctor who was, pursuant to the provisions of this sub-paragraph as in force immediately prior to 1st April 1990, relieved by the Committee of such responsibility in respect of his patients during times approved by the Committee may continue to enjoy such relief for so long as his name is included in the medical list.”.

7.  In paragraph 16–

(a)in sub-paragraph (1) for “(2) and (3)” there shall be substituted “(2), (3), (4) and (5)”;

(b)in sub-paragraph (2) after the words “maternity medical services” there shall be inserted the words “, child health surveillance services or minor surgery services”;

(c)after sub-paragraph (3) there shall be inserted the following paragraphs:–

“(4) In the case of child health surveillance services, a doctor who has, pursuant to paragraph 9A(a), undertaken to provide such services may employ for the purposes of providing such services a deputy or an assistant whose name is included in a child health surveillance list or, with the consent of the Committee, some other deputy or assistant.

(5) In the case of minor surgery services, a doctor who has, pursuant to paragraph 9A(b), undertaken to provide such services may employ a deputy or an assistant whose name is included in a minor surgery list to conduct a procedure described in Schedule 1B to these Regulations.”.

8.  After paragraph 24 there shall be inserted the following paragraph:—

“Employees

24A.—(1) A doctor shall, before employing any person to assist him in the provision of general medical services, take reasonable care to satisfy himself that the person in question is both suitably qualified and competent to discharge the duties for which he is to be employed.

(2) When considering the competence and suitability of any person for the purpose of sub-paragraph (1), a doctor shall have regard, in particular, to–

(a)that person’s academic and vocational qualifications;

(b)that person’s training and his experience in employment; and

(c)any guidance issued by the Committee pursuant to regulation 33B.

(3) A doctor shall afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee’s competence.”.

9.  For paragraph 25 there shall be substituted the following paragraphs:—

“Doctors' availability to patients

25.—(1) Any doctor whose name is included in a medical list shall, after 31st March 1990–

(a)normally be available at such times and places as shall have been approved by the Committee or, on appeal, by the Secretary of State in his case, in accordance with the requirements of the following provisions of this paragraph, following an application by the doctor; and

(b)inform his patients about his availability in such manner as the Committee may require in accordance with sub-paragraph (14).

(2) Subject to sub-paragraphs (3) and (4), a Committee shall not approve any application submitted by a doctor in relation to the times at which he is to be available unless it is satisfied that the times proposed are such that–

(a)the doctor will normally be available–

(i)in 42 weeks in any period of twelve months,

(ii)during not less than 26 hours in any such week, and

(iii)on 5 days in any such week; and

(b)the hours for which the doctor will normally be available in any week are to be allocated between the days on which he will normally be available in that week in such a manner as is likely to be convenient to his patients.

(3) On any application made pursuant to sub-paragraph (1) by a doctor who is a restricted services principal or a restricted list principal–

(a)sub-paragraph (2) shall not apply; and

(b)the Committee shall approve the application provided that it is satisfied that the times at which the doctor proposes normally to be available are likely to be convenient to his patients.

(4) The Committee may, in relation to the application of any doctor–

(a)who seeks normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a), excuse the doctor from the requirement of head (a)(iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 25A;

(b)who seeks normally to be available for either–

(i)less than 26 hours but not less than 19 hours, or

(ii)less than 19 hours but not less than 13 hours,

in any week referred to in sub-paragraph (2)(a), excuse the doctor from the requirements of head (a)(ii) and (iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 25B;

(c)to whom either paragraph 25C or 25D applies, excuse the doctor from the requirement of head (a)(ii) and (iii) of sub-paragraph (2) to the extent allowed by paragraph 25C or, as the case may be, paragraph 25D.

(5) In this paragraph and in paragraphs 25A to 25D, “available” means, in relation to a doctor, available to provide general medical services to his patients, and for the purposes of calculating the times at which a doctor is to be regarded as available–

(a)account may be taken of any period when the doctor is attending at his practice premises or at any clinic provided by him for his own patients, and of any time spent making a domiciliary visit; but

(b)no account shall be taken of time spent by the doctor holding himself in readiness to make a domiciliary visit if required by any patient;

and “availability” shall be construed accordingly.

(6) An application by a doctor in relation to any place at which he is to be available shall not be approved by the Committee unless it is satisfied that–

(a)the place at which the doctor proposes to be available is likely to be convenient to his patients;

(b)the location of that place is in accordance with any condition imposed in his case pursuant to section 33 of the National Health Service Act 1977(2) (distribution of general medical services).

(7) An application for approval pursuant to sub-paragraph (1) shall be made in writing to the Committee and shall–

(a)include the information specified in Part I of Schedule 1C to these Regulations; and

(b)where appropriate, also include–

(i)in the case of a doctor to whom sub-paragraph (3) applies, the additional information specified in Part II of that Schedule,

(ii)in the case of a doctor to whom sub-paragraph (4)(a) applies, the additional information specified in Part III of that Schedule,

(iii)in the case of a doctor to whom sub-paragraph (4)(b) applies, the additional information specified in Part IV of that Schedule,

(iv)in the case of a doctor to whom paragraph 25C(1) applies, the additional information specified in Part V of that Schedule, and

(v)in the case of a doctor to whom paragraph 25D(1) applies, the additional information specified in Part VI of that Schedule;

(c)be made–

(i)in the case of a doctor whose name is included in the medical list on 1st January 1990, by 1st February 1990,

(ii)in the case of a doctor who is notified after 1st January 1990 that his name is included in a medical list, within 28 days of his receiving such notification.

(8) The Committee shall determine an application within 28 days of receiving it.

(9) In determining any application, the Committee shall either–

(a)grant approval;

(b)grant approval subject to such conditions as the Committee sees fit to impose for the purpose of securing that the doctor is available at such times and places as are convenient to his patients; or

(c)refuse approval.

(10) The Committee shall notify the doctor in writing of its determination, and, where it refuses an application or grants an application subject to conditions, it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (11).

(11) A doctor may within 28 days of receiving a notification pursuant to sub-paragraph (10) appeal in writing to the Secretary of State against any refusal of approval or against any condition imposed pursuant to sub-paragraph (9).

(12) The Secretary of State may when determining an appeal either confirm the determination of the Committee or substitute his own determination for that of the Committee.

(13) The Secretary of State shall notify the doctor in writing of his determination and shall in every case include with the notification a written statement of the reasons for the determination.

(14) The Committee may, as it considers appropriate, require a doctor to inform his patients, by displaying a notice at his practice premises or sending notices to them, about the times and places at which he is available.

Doctors available for only 4 days a week

25A.—(1) Subject to sub-paragraph (3), where the Committee is satisfied that, by reason of a doctor’s participation in health-related activities (other than the provision of general medical services to his patients) he would be likely to suffer an unreasonable degree of inconvenience if paragraph 25(2)(a)(iii) applied in his case, it may give its approval for the doctor normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a) of that paragraph.

(2) For the purposes of sub-paragraph (1), “health-related activities” means activities connected with–

(a)the organisation of the medical profession or the training of its members;

(b)the provision of medical care or treatment;

(c)the improvement of the quality of such care or treatment; or

(d)the administration of services under Part I of the National Health Service Act 1977 or of arrangements pursuant to section 29 of that Act for the provision of general medical services,

and in determining whether any activity is a health-related activity, the Committee shall have regard to the illustrative list in Part VII of Schedule 1C to these Regulations.

(3) The Committee shall not give its approval in accordance with sub-paragraph (1) if, in its opinion–

(a)the effectiveness of the doctor’s services to his patients is likely to be significantly reduced; or

(b)his patients are likely to suffer significant inconvenience,

by reason of the doctor’s having been relieved from the requirements of paragraph 25(2)(a)(iii).

Doctors available for less than 26 hours a week

25B.—(1) Subject to sub-paragraph (2), the Committee may, in the case of a doctor–

(a)who practises in partnership with another doctor–

(i)whose name is included in the medical list, and

(ii)who is normally available for not less than 26 hours in each of the weeks referred to in paragraph 25(2)(a);

and

(b)who seeks normally to be available for either–

(i)less than 26 hours but not less than 19 hours, or

(ii)less than 19 hours but not less than 13 hours,

determine the application as if for the reference to 26 hours in paragraph 25(2)(a)(ii) there were substituted a reference to 19 hours or 13 hours, as the case may be.

(2) Any approval of an application which has been determined in accordance with sub-paragraph (1) shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which the doctor ceases to satisfy head (a) of that sub-paragraph.

Doctors jointly available for 26 hours a week

25C.—(1) Subject to sub-paragraph (2), where a doctor applies for the approval of the Committee pursuant to paragraph 25(1) jointly with another doctor–

(a)with whom he practises in partnership;

(b)whose name is included in the medical list; and

(c)with whom he proposes to operate an arrangement whereby–

(i)each doctor will normally be available for less than 26 hours in any week referred to in paragraph 25(2)(a), but

(ii)the hours for which both doctors will normally be available will in aggregate be not less than 26 hours in any such week,

the Committee may approve the application, notwithstanding that neither doctor can himself satisfy the requirement specified in paragraph 25(2)(a)(ii).

(2) Any approval of an application to which sub-paragraph (1) applies shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which the arrangement referred to in head (c) of that sub-paragraph comes to an end.

Doctors previously available for less than 20 hours a week

25D.—(1) Subject to sub-paragraph (3), where a doctor–

(a)does not practise in partnership with any other doctor;

(b)has no more than 599 patients on his list on 31st January 1990; and

(c)during the period of 12 months immediately preceding that date–

(i)was normally available for an average of less than 20 hours each week, and

(ii)in consequence, had his remuneration abated by the Committee, in accordance with the Statement published pursuant to regulation 24(1);

(d)seeks normally to be available, in each week referred to in regulation 25(2)(a), for not less than the number of hours for which he had, on average, been available in each week during the period mentioned in head (c) above,

the Committee may approve the application notwithstanding that the doctor will not normally be available in accordance with paragraph 25(2)(a)(ii).

(2) When calculating the average hours for the purposes of sub-paragraph (1)(c)(i), account shall be taken of the aggregate number of hours for which the doctor was normally available to patients in the localities of all Committees on whose medical lists his name was included.

(3) Any approval by the Committee in relation to a doctor to whom sub-paragraph (1) applies shall be subject to the condition that it shall lapse on 1st April 1991.”.

10.  After paragraph 29 (practice area) there shall be inserted the following paragraph:–

“Notification of change of place of residence

29A.  Where a doctor whose name is included in the medical list changes his place of residence he shall notify the Committee in writing of the change not later than 28 days after such change.”.

11.  In paragraph 32 (acceptance of fees) after sub-paragraph (1) there shall be added the following sub-paragraph:–

“(m)where the person is not one to whom any of paragraphs (a), (b) or (c) of section 38(1) of the National Health Service Act 1977(3) applies (including by reason of regulations under section 38(6) of that Act), for testing the sight of that person.”.

12.  After paragraph 38A there shall be inserted the following paragraph–

“Practice leaflet

38B.—(1) Subject to sub-paragraph (2), a doctor whose name is included in the medical list shall from 1st April 1990 compile in relation to his practice a document (in this paragraph called a “practice leaflet”) which shall include the information specified in Schedule 1D to these Regulations.

(2) Sub-paragraph (1) shall, in relation to a doctor referred to in regulation 4(2)(e), apply only to the extent that the Committee sees fit.

(3) A doctor shall review his practice leaflet at least once in every period of 12 months, and shall make any amendments necessary to maintain its accuracy.

(4) A doctor shall from 1st April 1990, or from such later date (being not later than 1st July 1990) as the Committee may allow, make available a copy of the most recent edition of his practice leaflet to the Committee, to each patient on his list and to any other person who, in the doctor’s opinion, reasonably requires one.

(5) A doctor who practises in partnership with other doctors whose names are included in the medical list shall satisfy the requirements of this paragraph if he makes available a practice leaflet, compiled and, where appropriate, revised in accordance with sub-paragraphs (1) and (3) which relates to the partnership as a whole; and in such a case a doctor may, if he so wishes, also produce a practice leaflet relating to his own activities.”.

13.  After paragraph 39 (reports to the medical officer, etc.) there shall be inserted the following paragraph:–

“Inquiries about prescriptions and referrals

39A.—(1) A doctor whose name is included in the medical list shall, subject to sub-paragraphs (2) and (3) below, sufficiently answer any inquiries, whether oral or in writing, from the Committee concerning–

(a)any prescription form issued by the doctor under these terms of service;

(b)the considerations by reference to which the doctor issues such forms under these terms of service;

(c)the referral by the doctor under these terms of service of any patient to any other services provided under the National Health Service Act 1977; and

(d)the considerations by reference to which the doctor refers patients to any such services.

(2) An inquiry referred to in sub-paragraph (1) may be made only for the purpose either of obtaining information to assist the Committee to discharge its functions or of assisting the doctor in the discharge of his obligations under these terms of servic

(3) A doctor shall not be obliged to answer any inquiry referred to in sub-paragraph (1) unless it is made by a doctor appointed under regulation 33A who produces on request written evidence that he is authorized by the Committee to make such an inquiry on behalf of the Committee.”.

14.  After paragraph 43 there shall be inserted the following paragraph:–

“Annual reports

43A.—(1) A doctor whose name is included in the medical list, shall provide annually to the Committee a report, in accordance with this paragraph, relating to the provision by him of personal medical services (in this paragraph called an “annual report”).

(2) An annual report shall contain the information specified in Schedule 1E to these Regulations.

(3) Each annual report shall be compiled in respect of the period of 12 months ending on the 31st March of the year in which it is provided and shall be sent to the Committee by 30th June of that year.

(4) The first annual report shall be sent to the Committee by 30th June 1991 and shall be compiled in respect of the period of 12 months ending on 31st March 1991.

(5) In the case of a doctor who practises in partnership with other doctors whose names are included in the medical list, the information referred to in sub-paragraph (2) may alternatively be provided in the form of an annual report in respect of the partnership as a whole instead of by each doctor in the partnership individually and in such a case a doctor may, if he so wishes, also provide his own annual report.

(6) Where a Committee requires that the information referred to in sub-paragraph (2) be provided on a form supplied by the Committee, the doctor shall use that form.

(7) A Committee shall not disclose any annual report to any person, unless otherwise lawfully empowered to do so.”.

regulation 21(b)

SCHEDULE 2

PART I(new part ii to be substituted in schedule 1 to the principal regulations)

“PART IIinformation and undertakings to be included in an application for inclusion in the medical list

1.  Full name.

2.  Sex.

3.  Date of birth.

4.  Private address.

5.  Medical qualifications and where obtained.

6.  Registration number in the Medical Register and date of first registration.

7.  Information about general medical services to be provided for persons in the Committee’s area, and in particular whether–

• (a)including maternity medical services

• excluding maternity medical services

• limited to maternity medical services

• (b)including contraceptive services

• excluding contraceptive services

• limited to contraceptive services

• (i)excluding fitting of intra uterine devices

• including fitting of intra uterine devices

• (ii)restricted to patients to whom GP or partner provides other personal medical services

• not restricted to patients to whom GP or partner provides other personal medical services

• (c)including child health surveillance services

• excluding child health surveillance services

• limited to child health surveillance services

• (d)including minor surgery services

• excluding minor surgery services

• limited to minor surgery services

8.  Present or most recent appointment.

9.—(a) Name(s) and address(es) of intended partner(s) and whether or not they are on the Committee’s Medical List.

(b)Names and addresses of members of group (other than those already specified in (a) above) with whom doctor intends to practise.

10.  Whether applied/intending to apply for inclusion on obstetric list/child health surveillance list/minor surgery list.

11.  Notification of proposed practice area (including street map).

12.  Notification of proposed practice premises.

13.  Notification of proposed days and hours of attendance.

14.  Proposed place of residence (including telephone number and distance from main surgery) and an undertaking to inform the Committee whenever changing permanent residence.

15.  Telephone number(s) at which prepared to receive messages.

16.  Undertaking that if accepting as a patient a person who at the time of acceptance is residing at a place outside the practice area he will visit him at that address.”

PART II(new part iii to be substituted in schedule 1 to the principal regulations)

“PART IIIinformation and undertakings to be included in an application to fill a vacancy

1.  Full name.

2.  Sex.

3.  Private address.

4.  Telephone number.

5.  Declaration that he is a registered medical practitioner, included in medical register in that name.

6.  Whether applying to succeed to a practice, or be appointed to a vacancy in practice.

7.  Address of that practice, practice area, practice premises.

8.  Intended days and hours of attendance.

9.  Telephone number(s) at which prepared to receive messages.

10.  Undertaking that if accepting as a patient a person who at the time of acceptance or succession is residing at a place outside the practice area he will visit him at that address.

11.  Date of birth.

12.  Date and place of medical registration, whether pursuant to the Medical Act 1983(4) or otherwise.

13.  Medical qualifications and where obtained.

14.  Registration number in the Medical Register and date of first registration.

15.  Whether or not on the medical list for the Committee’s locality.

16.  If not on Committee’s medical list, present or most recent appointment and, if in general practice, whether as principal, assistant or locum.

17.  Professional experience (including starting and finishing dates of each appointment) separated into:

(a)trainee or assistant experience in general practice;

(b)general practice experience;

(c)hospital appointments;

(d)other (including obstetric) experience;

(e)any additional supporting particulars.

18.  The name and address of principal to whom trainee or assistant.

19.  Particulars of covenants restricting medical practice by the applicant in the Committee’s locality.

20.  Name and address of intended partner(s) and whether or not their names are included in the Committee’s Medical List.

21.  Names and addresses of two referees.

22.  If applicant is not on Committee’s Medical List–

(1) name of any other Committee(s) on whose list he is included;

(2) if approved by local obstetric committee or if intending to apply to that Committee for approval of obstetric experience;

(3) particulars of any outstanding application for inclusion on the medical list of any Committee;

(4) information about general medical services to be provided and, in particular, whether–

• (a)including maternity medical services

• excluding maternity medical services

• limited to maternity medical services

• (b)including contraceptive services

• excluding contraceptive services

• limited to contraceptive services

• (i)excluding fitting of intra uterine devices

• including fitting of intra uterine devices

• (ii)restricted to patients to whom GP or partner provides other personal medical services

• not restricted to patients to whom GP or partner provides other personal medical services

• (c)including child health surveillance services

• excluding child health surveillance services

• limited to child health surveillance services

• (d)including minor surgery services

• excluding minor surgery services

• limited to minor surgery services

(5) whether or not intending to apply for–

(i)inclusion in minor surgery list,

(ii)inclusion in child health surveillance list;

(6)undertaking to be bound by terms of service.”

regulation 21(c)

SCHEDULE 3(NEW PARTS IV AND V TO BE ADDED TO SCHEDULE 1 TO THE PRINCIPAL REGULATIONS)

“PART IVinformation to be supplied by doctor applying for inclusion in a child health surveillance list

1.  Name.

2.  Address of practice premises.

3.  Registration number in the Medical Register and date of first registration.

4.  Details of relevant medical experience after date of first registration (and if appropriate before) during last 5 years, together with any references.

5.  Title of postgraduate qualifications held and date awarded.

PART Vinformation to be supplied by doctor applying for inclusion in a minor surgery list

1.  Name.

2.  Address of practice premises.

3.  Registration number in the Medical Register and date of first registration.

4.  Details of relevant medical experience after date of first registration (and if appropriate before) during last 5 years, together with any references.

5.  Details of premises and equipment to be used.

6.  Title of postgraduate qualifications held and date awarded.”

regulation 22

SCHEDULE 4(NEW SCHEDULE 1A TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

regulation 2(1) Schedule 1, paragraph 9B

“SCHEDULE 1ACHILD HEALTH SURVEILLANCE SERVICES

1.  The services referred to in paragraph 9B(a) of Schedule 1 shall comprise–

(a)the monitoring–

(i)by the consideration of information concerning the child received by or on behalf of the doctor, and

(ii)on any occasion when the child is examined or observed by or on behalf of the doctor (whether pursuant to sub-paragraph (b) or otherwise),

of the health, well-being and physical, mental and social development (all of which characteristics are referred to in this Schedule as “development”) of the child while under the age of 5 years with a view to detecting any deviations from normal development;

(b)the examination of the child by or on behalf of the doctor on so many occasions and at such intervals as shall have been agreed between the Committee and the health authority in whose district the child resides (in this Schedule called “the relevant health authority”) for the purposes of the provision of child health surveillance services generally in that district.

2.  The records mentioned in paragraph 9B(b) of Schedule 1 shall comprise an accurate record of–

(a)the development of the child while under the age of 5 years, compiled as soon as is reasonably practicable following the first examination mentioned in paragraph 1(a) of this Schedule and, where appropriate, amended following each subsequent examination mentioned in that sub-paragraph; and

(b)the responses (if any) to offers made to the child’s parent for the child to undergo any examination referred to in paragraph 1(b) of this Schedule.

3.  The information mentioned in paragraph 9B(c) of Schedule 1 shall comprise–

(a)a statement, to be prepared and dispatched to the relevant health authority referred to in paragraph 1(b) of this Schedule as soon as is reasonably practicable following any examination referred to in paragraph 1(a) of this Schedule, of the procedures undertaken in the course of that examination and of the doctor’s findings in relation to each such procedure;

(b)such further information regarding the development of the child while under the age of 5 years as the relevant health authority may request.”

regulation 22

SCHEDULE 5(NEW SCHEDULE 1B TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

regulation 2(1) Schedule 1, paragraph 9C

“SCHEDULE 1BMINOR SURGERY PROCEDURES

regulation 22

SCHEDULE 6(NEW SCHEDULE 1C TO BE INSERTED INTO THE PRINCIPAL REGULATIONS)

regulation 3(2) Schedule 1, paragraph 25

“SCHEDULE 1C

PART I

Information to be included with any application under paragraph 25 of Schedule 1

1.  The address of the proposed practice premises.

2.  The days in each week during which the doctor will normally be in attendance at the practice premises and available for consultation by his patients.

3.  The hours of each such attendance by the doctor.

4.  The hours of any attendance by the doctor on those occasions when he is not usually available to provide the full range of services specified in paragraph 13 of the terms of service (for example, for providing emergency treatment only).

5.  The frequency, duration and purpose of any clinic provided by the doctor.

6.  The estimated total time to be spent each week making any domiciliary visits.

7.  The doctor’s proposals for notifying patients of the times and places approved by the Committee.

8.  The terms of any condition imposed by the Medical Practices Committee or the Secretary of State under section 33 of the National Health Service Act 1977.

9.  In the case of a doctor to whom paragraph 15(2) of the terms of service does not apply, his proposals for discharging his continuous responsibility for his patients.

PART II

Additional information to be included in any application by a doctor who is a restricted services principal or a restricted list principal

1.  In the case of a restricted services principal–

(a)the proposed allocation of the total number of hours for which he is normally to be available in any week between each category of services provided; and

(b)where different services are to be provided at different places, the place at which each category of services is to be provided.

2.  In the case of a restricted list principal, the name, address and nature of the establishment(s) or organisations(s) with which his patients are connected.

PART III

Additional information to be included in any application by a doctor who seeks normally to be available on only 4 days in each week

1.  A brief description of each health-related activity with reference to which the application is made.

2.  The days in each week during which the doctor will be undertaking that activity.

3.  The number of hours in each week which are likely to be occupied in the course of such activity.

PART IV

Additional information to be included in any application by a doctor who seeks normally to be available for less than 26 hours in each week

1.  The level of reduced availability sought: either–

• not less than 19 hours; or

• not less than 13 hours.

2.  The proposed allocation of those hours between the days on which the doctor is normally to be available.

3.  The name(s) of the doctor’s partner(s).

4.  Whether such reduced availability is sought permanently or for only a temporary period.

PART V

Additional information to be included in any application made jointly by doctors to whom paragraph 25C(1) of the terms of service applies

1.  The name of the doctor’s partner who is joined in the application.

2.  The nature of the proposed arrangement, including–

(a)the hours for which each doctor will normally be available in each week; and

(b)the days on which each doctor will normally be available in each week.

PART VI

Additional information to be included in any application made by a doctor to whom paragraph 25D(1) of the terms of service applies

1.  Details of the doctor’s practice(s) in the locality of any other Committee(s) in whose medical list his name is included.

2.  The number of hours occupied in each week in the course of such practice(s).

PART VII

Illustrative list of health-related activities

• Appointments concerning medical education or training.

• Medical appointments within the health service other than in relation to the provision of general medical services.

• Medical appointments under the Crown, with Government Departments or Agencies, or public or local authorities.

• Appointments concerning the regulation of the medical profession or the Medical Practices Committee.”

regulation 22

SCHEDULE 7(NEW SCHEDULE 1D TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

regulation 3(2) Schedule 1, paragraph 38B

“SCHEDULE 1DINFORMATION TO BE INCLUDED IN PRACTICE LEAFLETS

Personal and Professional Details of the Doctor

1.  Full name.

2.  Sex.

3.  Medical qualifications registered by the General Medical Council.

4.  Date and place of first registration as medical practitioner.

Practice Information

5.  The times approved by the Committee during which the doctor is personally available for consultation by his patients at his practice premises.

6.  Whether an appointments system is operated by the doctor for consultations at his practice premises.

7.  If there is an appointments system, the method of obtaining a non-urgent appointment and the method of obtaining an urgent appointment.

8.  The method of obtaining a non-urgent domiciliary visit and the method of obtaining an urgent domiciliary visit.

9.  The doctor’s arrangements for providing personal medical services when he is not personally available.

10.  The method by which patients are to obtain repeat prescriptions from the doctor.

11.  If the doctor’s practice is a dispensing practice, the arrangements for dispensing prescriptions.

12.  If the doctor provides clinics for his patients, their frequency, duration and purpose.

13.  The numbers of staff, other than doctors, assisting the doctor in his practice, and a description of their roles.

14.  Whether the doctor provides (1) maternity medical services (2) contraceptive services (3) child health surveillance services (4) minor surgery services.

15.  Whether the doctor works single-handed, in partnership, part-time or on a job share basis, or within a group practice.

16.  The nature of any arrangements whereby the doctor or his staff receive patients' comments on his provision of general medical services.

17.  The geographical boundary of his practice area by reference to a map of a scale approved by the Committee.

18.  Whether the doctor’s practice premises have suitable access for all disabled patients and, if not, the reasons why they are unsuitable for particular types of disability.

19.  If an assistant is employed, details for him as specified in paragraphs 1–4 of this Schedule.

20.  If the practice either is a general practitioner training practice for the purposes of the National Health Service (Vocational Training) Regulations 1979(5) or undertakes the teaching of undergraduate medical students, the nature of arrangements for drawing this to the attention of patients.”

regulation 22

SCHEDULE 8(NEW SCHEDULE 1E TO BE INSERTED IN THE PRINCIPAL REGULATIONS)

regulation 3(2)

“SCHEDULE 1EINFORMATION TO BE PROVIDED IN ANNUAL REPORTS

1.  The number of staff, other than doctors, assisting the doctor in his practice by reference to–

(i)the total number but not by reference to their names;

(ii)the principal duties of each employee and the hours each week the employee assists the doctor;

(iii)the qualifications of each employee;

(iv)the relevant training undertaken by each employee during the preceding 5 years.

2.  The following information as respects the practice premises:–

(i)any variations in relation to floor space, design or quality since the last Annual Report.

(ii)any such variations anticipated in the course of the forthcoming period of 12 months.

3.  The following information as respects the referral of patients to other services under the National Health Service Act 1977 during the period of the Report:–

(a)as respects those by the doctor to a specialist–

(i)the total number of patients referred as in-patients;

(ii)the total number of patients referred as out-patients;

by reference in each case to whichever of the following clinical specialties applies and specifying in each case the name of the hospital concerned:

• General Surgical

• General Medical

• Orthopaedic

• Rheumatology (Physical Medicine)

• Ear, Nose and Throat

• Gynaecology

• Obstetrics

• Paediatrics

• Ophthalmology

• Psychiatry

• Geriatrics

• Dermatology

• Neurology

• Genito-urinary

• X-ray

• Pathology

• Others (including plastic surgery, accident and emergency, endocrinology);

(b)the total number of cases of which the doctor is aware (by reference to the categories listed in sub-paragraph (a)) in which a patient referred himself to services under the National Health Service Act 1977.

4.  The doctor’s other commitments as a medical practitioner with reference to–

(i)a description of any posts held; and

(ii)a description of all work undertaken,

including, in each case, the annual hourly commitment.

5.  The nature of any arrangements whereby the doctor or his staff receive patients' comments on his provision of general medical services.

6.  The following information as respects orders for drugs and appliances:–

(a)whether the doctor’s practice has its own formulary;

(b)whether the doctor uses a separate formulary;

(c)the doctor’s arrangements for the issue of repeat prescriptions to patients.”