National Health Service (Scotland) Act 1978

Part IIS Provision of Services

General ServicesS

18 Duty of Secretary of State.S

It shall be the duty of the Secretary of State to secure the provision of general medical, general dental and general ophthalmic services, and of pharmaceutical services, in accordance with the provisions of this Part.

General medical servicesS

19Arrangements and regulations for general medical services.S

(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.

[F1(f)for the making of arrangements for the temporary provision of general medical services in an area;

(g)for the circumstances in which a name added to the list by virtue of subsection (5) below may be removed from it.]

[F2(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.]

[F3(4)Regulations shall —

(a)include provision for the making to a medical practitioner providiong general medical services of payments in respect of qualifying services provided by a spouse or other relative of his; and

(b)provide that the rates and conditions of payment and the qualifying services in respect of which the payments may be made shall be such as may be determined by the Secretary of State after consultation with such bodies as he may recognise as representing such medical practitioners.]

[F4(5)The persons with whom arrangements for the temporary provision of general medical services in an area may be made by virtue of regulations under subsection (2) include medical practitioners who are not on the list of medical practitioners providing such services in the area, and the power to prepare and publish lists of medical practitioners conferred by paragraph (a) of that subsection accordingly includes power to add the names of medical practitioners with whom such arrangements are made to the lists.

(6)Regulations may provide that this Act and any regulations made under it shall apply in relation—

(a)to the making of arrangements for the temporary provision of general medical services; and

(b)to the provision of general medical services in pursuance of any such arrangements,

subject to such modifications as may be specified in the regulations.

(7)Where the registration of a medical practitioner in the register of medical practitioners is suspended—

(a)by a direction of the Health Committee of the General Medical Council under [F5section 37(1) or (2) of the Medical Act 1983] (unfitness to practise by reason of physical or mental condition);

(b)by an Order of that Committee under [F5section 38(1)] of that Act (order for immediate suspension); or

(c)by an interim order of the preliminary Proceedings Committee of the Council under [F5section 42(3)(b)] of that Act,

the suspension shall not terminate any arrangements made with him for the provision of general medical services; but he shall not provide such services in person during that period of suspension.]

[F6(8)In relation to a medical practitioner, any reference in this Act to the relevant Health Board shall be construed as follows—

(a)if he practises in partnership with other medical practitioners, the relevant Health Board is the Board on whose medical list the members of the practice are included and, if some are included on one Board’s medical list and some on another’s or if any of the members is included on the medical lists of two or more Boards, the relevant Health Board is the Board in whose area resides the largest number of individuals who are on the lists of patients of members of the practice; and

(b)in any other case, the relevant Health Board is the Board on whose medical list he is included and, if there is more than one, the Board in whose area resides the largest number of individuals who are on his list of patients.]

20 Applications to provide general medical services.S

(1)[F9Subject to subsection (1A) below] 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 F10 any medical practitioner whose application is granted by that Committee shall [F11subject to the provisions of this Part of this Act relating to the disqualification of practitioners] be entitled to the inclusion of his name in the list.

[F12(1A)No medical practitioner who is a national of a member State and is registered by virtue of a qualification granted in a member State shall be entitled to have his application for the inclusion of his name in the list kept by any Health Board referred to the Medical Practices Committee unless he satisfies the Board that he has that knowledge of English which, in the interests of himself and his patients, is necessary for the provision of general medical services in the Board’s area; and where a Board is not so satisifed with respect to any applicant the Board shall not refer his application to the Committee.]

(2)F13

21 Requirement of suitable experience.S

(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.S

(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.S

(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.

[F14(1A)The Secretary of State may by order specify the maximum number of medical practitioners with whom, in any year, all Health Boards taken as a whole may enter into arrangements under section 19 for the provision of general medical services.

(1B)An order under subsection (1A) may contain such incidental and consequential provisions (including provisions amending this Part of this Act) as appear to the Secretary of State to be appropriate including, in particular, provisions as to the basis on which the Medical Practices Committee are to refuse applications under section 20 in order to secure that any maximum number specified in the order is not exceeded.]

(2)[F15Subject to subsection (2A)] 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.

[F16(2A)If, in the opinion of the Medical Practices Committee, a medical practitioner is required for a particular part of the area of a Health Board, then, in such circumstances as may be prescribed,—

(a)the Board shall, in accordance with regulations, select the medical practitioner whose application they wish to be considered by the Committee; and

(b)the Committee shall not consider any application from a medical practitioner who is not so selected; and

(c)any medical practitioner who has made an application but is not so selected may appeal to the Secretary of State on a point of law;

and if the Secretary of State allows an appeal under paragraph (c) he shall remit the application to the Board for reconsideration.]

(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

[F17(a)in granting an application shall specify, by reference to one or more prescribed conditions relating to hours or the sharing of work, the provision of general medical services for which the applicant will be entitled to be remunerated; and

(b)]the Committee may grant an application subject to conditions excluding the provision of general medical services by the applicant in such part of parts of the area of the Health Board as the Committee may specify.[F18and an order under subsection (1A) may make provision as to the extent to which account is to be taken under the order of medical practitioners whose ability to carry out renumerated work is limited by virtue of conditions imposed under paragraph (a)]

(5)A medical practitioner who has made an application under section 20 which has been refused [F19by the Medical Practices Committee] or has been granted [F19by that Committee] subject to [F20such conditions][F20conditions under paragraph (a) or (b) of subsection (4)] may appeal to the Secretary of State [F21; 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][F21on a point of law; and, if the Secretary of State allows such an appeal, he shall remit the application to the Medical Practices Committee for reconsideration].

[F21This subsection does not apply where an application has been refused under paragraph (a) of section 21(1) [F22or under section 8 of the Health and Medicines Act 1988 (persons over retiring age) and regulations under that section].]

(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.

[F23(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)[F24The 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][F24In any case where medical practitioners have to be selected from a number of applicants, the Medical Practices Committee or, where subsection (2A) applies, the Health Board shall]—

(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.S

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 [F25and, where such an appeal is allowed, the reconsideration of any application]; and

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

[F26(2)Regulations under this section may make provision for, and in connection with, the variation of any condition imposed under subsection (4) or (5) of section 23 including provision for appeals to the Secretary of State on a point of law.]

General dental servicesS

25 Arrangements for provision of general dental services.S

(1)It shall be the duty of every Health Board, in accordance with regulations, to make as respects their area arrangements with dental practitioners under which any person for whom a dental practitioner undertakes in accordance with the arrangements to provide dental treatment and appliances shall receive such treatment and appliances; and the services provided in accordance with those arrangements are in this Act referred to as “general dental services”.

(2)Regulations may make provision as to the arrangements to be made under subsection (1), and shall include provision—

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

[F30(b)for conferring a right, subject to—

(i)[F31subsections (2A) and (2B)]

(ii)the provisions of this Part relating to the disqualification of persons providing services; and

(iii)section 8 (persons over retiring age) of the Health and Medicines Act 1988 and regulations made under that section,

on any dental practitioner who wishes to be included in any such list to be so included;]

(c)for conferring a right on any person to choose in accordance with the prescribed procedure the dental practitioner from whom he is to receive general dental services, subject to the consent of the practitioner so chosen;

(d)for the removal from the list of dental practitioners undertaking to provide general dental services for persons in any area of the name of a dental 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 dental services for persons in that area.

[F32(2A)No dental practitioner who is a national of a member State and is registered by virtue of a qualification granted in a member State shall be entitled to have his name included in the list kept by a Health Board unless he satisfies the Board that he has that knowledge of English which, in the interests of himself and his patients, is necessary for the provisions of general dental services in the Board’s area.]

[F33(2B)Regulations may make the exercise of the right conferred by virtue of paragraph (b) of subsection (2) subject to any provision made by or under the regulations, and, in such cases as may be prescribed, may confer a right of appeal to a prescribed body in respect of a refusal to include a dental practitioner on such a list as is referred to in paragraph (a) of that subsection.]

(3)The remuneration to be paid under arrangements made under this section to a dental practitioner who provides general dental services elsewhere than at a health centre shall not, F34, consist wholly or mainly of a fixed salary [F35unless either—

(a)the remuneration is paid in pursuance of arrangements made under section 33, or

(b)the services are provided in prescribed circumstances and the practitioner consents,

and it shall be the Secretary of State’s duty, before he prescribes any circumstances for the purposes of paragraph (b), to consult such organisations as appear to him to be representative of the dental profession.]

[F36(4)Where the registration of a dental practitioner in the dentists register is suspended—

(a)by an order under [F37section 32 of the Dentists Act 1984] (interim suspension); or

(b)by a direction or [F38an order of the Health Committee under] that Act (health cases),

the suspension shall not terminate any arrangements made with him for the provision of general dental services, but he shall not provide such services in person during the suspension.

(5)Regulations may provide for the making of payments in consequence of suspension to a dental practitioner whose registration is so suspended.]

General ophthalmic servicesS

26 Arrangements for provision of general ophthalmic services.S

(1)It shall be the duty of every Health Board to make as respects their area, in accordance with regulations, arrangements with medical practitioners having the prescribed qualifications, [F39and with ophthalmic opticians], for securing [F40the testing by such practitioners and opticians of the sight—

(a)of a child;

(b)of a person whose resources fall to be treated under the regulations as being less than his requirements or as being equal to his requirements; or

(c)of a person of such other description as may be prescribed.

(1A)In this section—

• “child” means—

(a)a person who is under the age of 16 years; or

(b)a person who is under the age of 19 years and receiving qualifying full-time education; and

(1B)Regulations under this section may direct how a person’s resources and requirements are to be calculated and, without pre-judice to the generality of this subsection, may direct that they shall be calculated—

(a)by a method set out in the regulations;

(b)by a method described by reference to a method of calculating or estimating income or capital specified in an enactment other than this section or in an instrument made under an Act of Parliament or by reference to such a method but subject to prescribed modifications;

(c)by reference to an amount applicable for the purposes of a payment under an Act of Parliament or an instrument made under an Act of Parliament; or

(d)by reference to the person’s being, or having been, entitled to payment under an Act of Parliament or an instrument made under an Act of Parliament.

(1C)Descriptions of persons may be prescribed for the purposes of subsection (1) above by reference to any criterion and, without prejudice to the generality of this subsection, by reference to any of the following criteria—

(a)their age;

(b)the fact that a prescribed person or a prescribed body accepts them as suffering from a prescribed medical condition;

(c)the fact that a prescribed person or a prescribed body accepts that a prescribed medical condition from which they suffer arose in prescribed circumstances;

(d)their receipt of benefit in money or in kind under any enactment or their entitlement to receive any such benefit; and

(e)the receipt of any such benefit by other persons satisfying prescribed conditions or the entitlement of other persons satisfying prescribed conditions to receive such benefits.

(1D)Regulations which refer to an Act of Parliament or an instrument made under an Act of Parliament may direct that the reference is to be construed as a reference to that Act or instrument—

(a)as it has effect at the time when the regulations are made; or

(b)both as it has effect at that time and as amended subsequently.

(1E)Regulations may provide that a person—

(a)whose sight is tested by a person who provides general ophthalmic services; and

(b)who is shown during the testing or within a prescribed time after it to fall within subsection (1) above,

shall be taken for the purposes of the testing to have so fallen immediately before his sight was tested; and the testing shall be treated—

(i)for the purposes of any arrangements under this section;

(ii)for the purposes of remuneration in respect of the testing; and

(iii)for any such other purpose as may be prescribed, as a testing of sight under this Act.

(1F)Regulations shall define the services for the provision of which arrangements under this section are to be made and the services so defined are in this Act referred to as “general ophthalmic services”.]

(2)Regulations may make provision as to the arrangements to be made under subsection (1), and shall include provision—

(a)for the preparation and publication of lists of medical practitioners, [F41and opthalmic opticians] respectively who undertake to provide general ophthalmic services;

(b)for conferring a right, subject to the provisions of this Act relating to the disqualification of practitioners, on any medical practitioner having the prescribed qualifications, [F42or any ophthalmic optician], who wishes to be included in the appropriate list, to be so included;

(c)for conferring on any person a right to choose in accordance with the prescribed procedure the medical practitioner or ophthalmic optician by whom his sight is to be tested or from whom any prescription for the supply of optical appliances is to be obtained F43;

(d)for the removal from the list of medical practitioners, [F44or ophthalmic opticians] undertaking to provide general ophthalmic services for persons in any area of the name of a medical practitioner, [F45or opthalmic optician], as the case may be, 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 ophthalmic services for persons in that area.

(3)The power conferred by this section to prescribe the qualifications to be possessed by any medical practitioner includes—

(a)power to prescribe a requirement that the practitioner shall show, to the satisfaction of a committee recognised by the Secretary of State for the purpose, that he possesses such qualifications (including qualifications as to experience) as may be mentioned in the regulations, and

(b)power to confer on a person who is dissatisfied with the determination of such a committee, a right of appeal to a committee appointed by the Secretary of State, and to make provision for any matter for which it appears to the Secretary of State to be requisite or expedient to make provision in consequence of the conferring of that right.

Pharmaceutical servicesS

27 Arrangements for provision of pharmaceutical services.S

(1)It shall be the duty of every Health Board to make, in accordance with regulations, arrangements as respects its area for the [F46provision] to persons who are in that area of—

(a)proper and sufficient drugs and medicines and listed appliances which are ordered for those persons by a medical practitioner in pursuance of his functions in the health service, the health service for England and Wales, the Northern Ireland health service or the armed forces of the Crown (excluding forces of a Commonwealth country and forces raised in a colony), and

[F47(b)proper and sufficient drugs and medicines which are ordered for those persons by a dental practitioner in pursuance of the provision by that Board [F48or by an NHS trust] of dental services; and

(c)listed drugs and medicines which are ordered for those persons by a dental practitioner in pursuance of the provision by him of general dental services [F49; and

(d)such services as may be prescribed,]]

and the [F50provision of drugs, medicines, appliances and services in accordance with the arrangements is] in this Act referred to as “pharmaceutical services”.

In this subsection—

• “listed” means included in a list for the time being approved by the Secretary of State for the purposes of this subsection;

• “the health service for England and Wales” and “the Northern Ireland health service” mean respectively the health service established in pursuance of section 1 of the M2National Health Service Act 1946 or any service provided in pursuance of Article 4(a) of the M3Health and Personal Social Services (Northern Ireland) Order 1972.

[F51(2)Regulations shall provide for securing that arrangements made by a Health Board under subsection (1) will enable persons in the Board’s area for whom drugs, medicines or appliances mentioned in that subsection are ordered as there mentioned [F52, or to whom services mentioned in subsection (1)(d) are to be provided,] to receive them from persons with whom such arrangements have been made.

(3)The regulations shall include provision—

(a)for the preparation and publication by a Health Board of one or more lists of persons, other than medical practitioners and dental practitioners, who undertake to provide pharmaceutical services from premises in the Board’s area;

(b)that an application to a Health Board for inclusion in such a list shall be made in the prescribed manner and shall state—

(i)the [F53pharmaceutical] services which the applicant will undertake to provide and, if they consist of or include the supply of appliances, which appliances he will undertake to supply; and

(ii)the premises from which he will undertake to provide those services;

(c)that, except in prescribed cases—

(i)an application for inclusion in such a list by a person not already included; and

(ii)an application by a person already included in such a list for inclusion also in respect of [F53pharmaceutical] services or premises other than those already listed in relation to him,

shall be granted only if the Health Board is satisfied, in accordance with the regulations, that it is necessary or desirable to grant it in order to secure in the neighbourhood in which the premises are located the adequate provision by persons included in the list of the services, or some of the services, specified in the application; and

(d)for the removal of an entry in respect of premises from a list if it has been determined in the prescribed manner that the person to whom the entry relates—

(i)has never provided from those premises; or

(ii)has ceased to provide from them, the [F53pharmaceutical] services, or any of the services, which he is listed as undertaking to provide from them.

(4)The regulations may include provision—

(a)that an application to a Health Board may be granted in respect of some only of the [F53pharmaceutical] services specified in it;

(b)that an application to a Health Board relating to [F53pharmaceutical] services of a prescribed description shall be granted only if it appears to the Board that the applicant has satisfied such conditions with regard to the provision of those [F53pharmaceutical] services as may be prescribed;

[F54(ba)that an application to a Health Board by a person who qualified to have his name registered under the Pharmacy Act 1954 by virtue of section 4A of that Act (qualification by European diploma) shall not be granted unless the applicant satisfies the Board that he has the knowledge of English which, in the interests of himself and the persons making use of the services to which the application relates, is necessary for the provision of pharmaceutical services in the Board’s area.]

(c)that the inclusion of a person in a list in pursuance of such an application may be for a fixed period;

(d)that, where the premises from which an application states that the applicant will undertake to provide [F53pharmaceutical] services are in an area of a prescribed description, the applicant shall not be included in the list unless his inclusion is approved by a prescribed body and by reference to [F55prescribed criteria]; and

(e)that the prescribed body may give its approval subject to conditions.

(5)The regulations shall include provision conferring on such persons as may be prescribed rights of appeal from decisions made by virtue of subsection (3) or (4).

(6)The regulations shall be so framed as to preclude—

(a)a person included in a list published under subsection (3)(a) above; and

(b)an employee of such a person;

from taking part in the decision whether an application such as is mentioned in subsection (3)(c) above should be granted or an appeal against such a decision brought by virtue of subsection (5) above should be allowed.]

28 Persons authorised to provide pharmaceutical services.S

(1)Except as may be provided by [F58or under] regulations, no arrangements shall be made by a Health Board with a medical practitioner or dental practitioner under which he is required or agrees to provide pharmaceutical services to any person to whom he is rendering general medical services or general dental services.

(2)Except as may be provided by [F59or under] regulations, no arrangements for the dispensing of medicines [F60or the provision of pharmaceutical services] shall be made with persons other than persons who are registered pharmacists or are persons lawfully conducting a retail pharmacy business in accordance with section 69 of the M7Medicines Act 1968, and who undertake [F61(a)] that all medicines [F62provided] by them under the arrangements made under this Part shall be dispensed [F63, and (b) that all services mentioned in section 27(1)(d) provided by them under those arrangements shall be provided] either by, or under the direct supervision of, a registered pharmacist.

[F64 Remuneration for services]S

28A Regulations as to remuneration.S

(1)Regulations shall make provision as to the remuneration to be paid to persons who provide general medical services, general dental services, general ophthalmic services or pharmaceutical services under this Part of this Act [F65and may include provision for the remuneration of persons providing those services in respect of the instruction of any person in matters relating to those services]

(2)Subject to sections 19(3) and 25(3), remuneration under the regulations may consist of payments by way of—

(a)salary;

(b)fees;

(c)allowances;

(d)reimbursement (in full or in part) of expenses incurred or expected to be incurred in connection with the provision of the services [F66or instruction].

and the regulations may provide that the remuneration shall be determined from time to time by such authority as may be specified.

(3)If section 10 of the National Health Service Act M81966 is brought into operation, upon the date of its commencement the words “section 10 of the National Health Service Act 1966 and section" shall be substituted for the words “sections 19(3) and" in subsection (2) above.

[F6728B Remuneration— supplementary.S

(1)The authority specified in regulations under the preceding section may be the Secretary of State or some other person or persons and is referred to in this section as a “determining authority”.

(2)The power conferred by the preceding section includes power to make regulations providing for a determination in more than one stage and by more than one determining authority.

(3)Regulations under the preceding section shall provide—

(a)that determination may be made with respect either to any of the descriptions of services mentioned in subsection (1) of the preceding section generally or to any category of services falling within such a description;

(b)that, before making such a determination, the determining authority shall consult—

(i)a prescribed body established to provide advice in connection with the matters to be determined; or

(ii)an organisation appearing to the Secretary of State to be representative of persons to whose remuneration the determination would relate,

or both such a body and such an organisation.

(4)Regulations under the preceding section may provide—

(a)that a determination such as is mentioned in subsection (3) above shall have effect in relation to remuneration in respect of a period beginning on or after a date specified in the determination, which may be the date of the determination or an earlier or later date, but may be an earlier date only if, taking the determination as a whole, it is not detrimental to the persons to whose remuneration it relates; and

(b)that any such determination which does not specify such a date shall have effect in relation to remuneration in respect of a period beginning—

(i)if it is required to be published, on the date of publication;

(ii)if it is not so required, on the date on which it is made.

(5)Regulations under the preceding section may provide—

(a)for determinations of the remuneration of particular persons or descriptions of persons for particular items of service or in particular circumstances;

(b)that a determining authority shall have a discretion, when making a determination by virtue of this subsection,—

(i)as to the amount of remuneration to be paid; and

(ii)as to the persons to whom and conditions on which it is to be paid; and

(c)that a determination made by virtue of this subsection may be revised—

(i)to correct an error; or

(ii)where it appears to the determining authority that it was made in ignorance of or under a mistake as to a relevant fact.

(6)Regulations under the preceding section may provide—

(a)that determinations may be made by reference to any of the following—

(i)rates or conditions of remuneration of any persons or any descriptions of persons which are fixed or determined, or to be fixed or determined, otherwise than by way of a determination under the regulations;

(ii)scales, indices or other data of any description specified in the regulations; and

(b)that any determination which in accordance with regulations made by virtue of paragraph (a)(ii) above falls to be made by reference to a scale or an index or to any other data may be made not only by reference to that index or scale or those data in the form current at the time of the determination but also by reference to the scale, index or data in any subsequent form attributable to amendment or revision taking effect after that time or to any other cause.

(7)Any determination under regulations under the previous section shall be made after taking into account all the matters which are considered to be relevant by the determining authority and, without prejudice to the generality of this subsection, such matters may include—

(a)the amount or estimated amount of expenses (taking into account any discounts) incurred in the past or likely to be incurred in the future (whether or not by persons to whose remuneration the determination will relate) in connection with the provision of services of [F68the description to which the determination will relate or of any category falling within that description];

(b)the amount or estimated amount of any remuneration paid or likely to be paid to persons providing such services;

(c)the amount or estimated amount of any other payments or repayments or other benefits received or likely to be received by any such persons;

[F69(d)the extent to which it is desirable to encourage the provision, either generally or in particular places, of the description or category of services to which the determination will relate;]

(e)the desirability of promoting services which are—

(i)economic and efficient; and

(ii)of an appropriate standard.

[F70(8)If the determination is of remuneration for a category of services falling within one of the descriptions of services mentioned in subsection (1) of the preceding section, the reference in subsection (7)(a) above to a category of services is a reference to the same category of services or to any other category of services falling within the same description.]]

Provisions as to disqualification of practitionersS

29 Disqualification of persons providing services.S

(1)There shall be constituted a tribunal (hereafter in this Act referred to as “the Tribunal”) for the purpose of inquiring into cases where representations are made in the prescribed manner to the Tribunal by a Health Board or any other person that the continued inclusion of any person in any list prepared under this Part—

(a)of medical practitioners undertaking to provide general medical services;

(b)of medical practitioners undertaking to provide general ophthalmic services;

(c)of dental practitioners undertaking to provide general dental services;

(d)of ophthalmic opticians undertaking to provide general ophthalmic services;

(e)

F73(f)of persons undertaking to provide pharmaceutical services,

would be prejudicial to the efficiency of the services in question.

(2)Schedule 8 shall have effect in relation to the Tribunal.

(3)The Tribunal, on receiving representations from a Health Board, shall, and in any other case may, inquire into the case and, if they are of the opinion that the continued inclusion of the said person in any list to which the representations relate would be prejudicial to the efficiency of the said services, shall direct that his name be removed from that list, and may also, if they think fit, direct that his name be removed from, or not be included in, any corresponding list kept by any other Health Board under this Part.

(4)An appeal shall lie to the Secretary of State from any direction of the Tribunal under subsection (3), and the Secretary of State may confirm or revoke that direction in whole or in part.

(5)Where the Tribunal direct that the name of any person be removed from, or not included in, any list or lists, the Health Board or Boards concerned shall—

(a)if no appeal is brought, at the end of the period for bringing an appeal, or

(b)if an appeal is brought and the direction of the Tribunal as regards any such list or lists is confirmed by the Secretary of State, on receiving notice of the Secretary of State’s decision,

remove the name of the person concerned from the list or lists in question.

(6)The references in subsections (1), (3) and (5) to a Health Board shall include a reference to such committee or joint committee as may be prescribed.

30 Removal of disqualification.S

(1)Any person whose name has been removed by a direction under section 29 from any list or lists shall be disqualified for inclusion in any list to which that direction relates until the Tribunal or the Secretary of State direct under this section to the contrary.

(2)For the purpose of deciding whether or not to issue a direction under this section (or under paragraph 6 of Schedule 15) the Tribunal or the Secretary of State, as the case may be, may hold an inquiry.

31 Disqualification provisions in England or Wales or Northern Ireland.S

If—

(a)under any provisions in force in England or Wales or Northern Ireland corresponding to the provisions of this Part, a person is for the time being disqualified for inclusion in all lists prepared under those provisions of persons undertaking to provide services of one or more of the kinds specified in section 29(1), then

(b)that person shall, so long as that disqualification is in force, be disqualified for inclusion in a list prepared under this Part of persons undertaking to provide services of that kind or those kinds, and the name of that person shall be removed from any such list in which his name is included.

32 Regulations as to sections 29 to 31.S

Regulations shall make provision—

(a)with regard to the procedure for the holding of inquiries by the Tribunal or the Secretary of State under sections 29 to 31 and for the making and determining of appeals to the Secretary of State under that procedure, and, in particular, for securing that any person who is the subject of such an inquiry shall be informed, as soon as may be, of the substance of any charge or complaint to which the inquiry relates and shall have an opportunity—

(i)of appearing, either in person or by counsel or solicitor or such other representative as may be prescribed, before the Tribunal and, in the case of an inquiry by, or appeal to, the Secretary of State, before a person appointed by the Secretary of State, and

(ii)of being heard by the Tribunal or the person so appointed, and of calling witnesses and producing other evidence on his behalf,

and that the hearing, whether by the Tribunal or the person so appointed, shall be in public if the person who is the subject of the inquiry so requests;

(b)for conferring on the Tribunal and on any person so appointed such powers as the Secretary of State considers necessary for the purpose of holding such inquiries, including power to require the attendance of witnesses and the production of documents and to administer oaths; and

(c)for the publication of decisions of the Tribunal and the Secretary of State under this section and of the imposition and removal of any disqualification imposed by virtue of this section, and for the intimation to any person who is the subject of such an inquiry of the grounds upon which any disqualification has been imposed in his case.

Supplementary provisions relating to Part IIS

33 Powers of Secretary of State where services are inadequate.S

If the Secretary of State is satisfied, after such inquiry as he may think fit, as respects the area of any Health Board or part of any such area that the persons included in any list prepared under this Part—

(a)of medical practitioners undertaking to provide general medical services,

(b)of dental practitioners undertaking to provide general dental services,

(c)of persons undertaking to provide general ophthalmic services, or

(d)of persons undertaking to provide pharmaceutical services,

are not such as to secure the adequate provision of the services in question in that area or part, or that for any other reason any considerable number of persons in any such area or part are not receiving satisfactory services under the arrangements in force under this Part, he may authorise the Health Board to make such other arrangements as he may approve, or may himself make other arrangements, and may dispense with any of the requirements of regulations made under this Part so far as appears to him to be necessary to meet exceptional circumstances and enable such arrangements to be made.

34 Exercise of choice of medical practitioner etc. in certain cases.S

Regulations may provide that where a right to choose the person by whom services are to be provided under this Part is conferred by or under any provision of this Part, that right shall, in the case of such persons as may be specified in the regulations, be exercisable on their behalf by other persons so specified.

35 Prohibition of sale of medical practices.S

(1)Where the name of any medical practitioner is or has been at any time on or after 5th July 1948 entered in any list of medical practitioners undertaking to provide general medical services, it shall be unlawful subsequently to sell the goodwill or any part of the goodwill of the medical practice of that medical practitioner.

This subsection is subject to subsections (2) and (3); and the additional provisions contained in Schedule 9 have effect for the purposes of this section.

(2)Where a medical practitioner, whose name has ceased to be entered in any list of medical practitioners undertaking to provide general medical services, practises in an area for which he has never been on any such list, subsection (1) does not render unlawful the sale of the goodwill or any part of the goodwill of his practice in that area.

(3)Subsection (1) does not prevent the sale of the goodwill or any part of the goodwill of a medical practice carried on in any area, being a sale by a medical practitioner whose name has never been entered in a list of a Health Board (or of an Executive Council) for that area of medical practitioners undertaking to provide general medical services, notwithstanding that any part of the goodwill to be sold is attributable to a practice previously carried on by a person whose name was entered in such a list.