National Health Service (Primary Care) Act 1997

Part IIU.K. Primary Care

Personal medical or dental servicesU.K.

21 Provision of personal medical or dental services.U.K.

F1(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 17B, insert—

“ Provision of personal medical or dental servicesU.K.

17C Personal medical or dental services.

(1)A Health Board may make one or more agreements with respect to their area, in accordance with the provisions of regulations under section 17E, under which—

(a)personal medical services are provided (otherwise than by the Board); or

(b)personal dental services are provided (otherwise than by the Board).

(2)An agreement made under this section—

(a)may not combine arrangements for the provision of personal medical services with arrangements for the provision of personal dental services; but

(b)may include arrangements for the provision of services—

(i)which are not personal medical services or personal dental services; but

(ii)which may be provided under this Part.

(3)Except to such extent as may be prescribed—

(a)a patient for whom personal medical services are provided in accordance with an agreement made under this section is not to count as a person for whom arrangements must be made by the Health Board concerned under section 19;

(b)a patient for whom personal dental services are provided under an agreement made under this section is not to count as a person for whom arrangements must be made by the Health Board concerned under section 25.

(4)This Act (and in particular section 2) has effect, in relation to personal medical services or personal dental services provided under an agreement made under this section, as if those services were provided as a result of the delegation by the Secretary of State (by directions given under section 2) of functions of his under this Part.

(5)Regulations may provide—

(a)for functions which are exercisable by a Health Board in relation to an agreement made under this section to be exercisable on behalf of the Board by a Health Authority; and

(b)for functions which are exercisable by a Health Authority in relation to an agreement made under section 28C of the M1National Health Service Act 1977 to be exercisable on behalf of the Authority by a Health Board.

(6)For the purposes of this section—

• “Health Authority” has the same meaning as in the National Health Service Act 1977;

• “personal medical services” means medical services of a kind that may be provided by a general medical practitioner in accordance with arrangements made under Part II; and

• “personal dental services” means dental services of a kind that may be provided by a general dental practitioner in accordance with arrangements made under Part II.

17D Persons with whom agreements may be made.

(1)A Health Board may make an agreement under section 17C only with one or more of the following—

(a)an NHS trust;

(b)in the case of an agreement under which personal medical services are provided—

(i)a qualifying medical practitioner;

(ii)an individual who is providing personal medical services in accordance with section 17C arrangements or section 28C arrangements;

(c)in the case of an agreement under which personal dental services are provided—

(i)a qualifying dental practitioner;

(ii)an individual who is providing personal dental services in accordance with section 17C arrangements or section 28C arrangements;

(d)an NHS employee, a section 17C employee or a section 28C employee;

(e)a qualifying body.

(2)In this section—

• “the 1977 Act” means the M2National Health Service Act 1977;

• “NHS employee” means an individual who, in connection with the provision of services in the health service in Scotland or England and Wales, is employed by—

  (a)

  an NHS trust;

  (b)

  in the case of an agreement under which personal medical services are provided—

  (i)

  a medical practitioner whose name is included in a medical list kept under this Act or in a corresponding list kept under the 1977 Act; or

  (ii)

  a medical practitioner who is providing personal medical services in accordance with section 17C arrangements or section 28C arrangements;

  (c)

  in the case of an agreement under which personal dental services are provided—

  (i)

  a dental practitioner whose name is included in a list prepared in accordance with regulations made under section 25(2)(a) of this Act or section 36(1)(a) of the 1977 Act; or

  (ii)

  a dental practitioner who is providing personal dental services in accordance with section 17C arrangements or section 28C arrangements;

• “qualifying body” means—

  (a)

  a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraphs (a) to (d) of subsection (1); and also

  (b)

  in the case of an agreement under which personal dental services are provided, a body corporate which, in accordance with the provisions of Part IV of the M3Dentists Act 1984, is entitled to carry on the business of dentistry;

• “qualifying dental practitioner” means a dental practitioner who satisfies the conditions imposed by regulations made under section 17E(2)(b) of this Act or section 28E(2)(b) of the 1977 Act;

• “qualifying medical practitioner” means a medical practitioner who satisfies the conditions imposed by regulations made under section 17E(2)(b) of this Act or section 28E(2)(b) of the 1977 Act;

• “section 17C employee” means an individual who, in connection with the provision of services in accordance with section 17C arrangements, is employed by an individual providing those services;

• “section 28C arrangements” means arrangements for the provision of services made under section 28C of the 1977 Act; and

• “section 28C employee” means an individual who, in connection with the provision of services in accordance with section 28C arrangements, is employed by an individual providing those services.”

(3)The Secretary of State may not make an order under section 41(3) bringing this section into force unless he is satisfied, having regard in particular to reviews of pilot schemes which have been conducted under section 7, that it would be in the interests of any part of the health service to bring this section into force.

22 Supplementary regulations.U.K.

F2(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 17D, insert—

“17E Personal medical or dental services: regulations.

(1)The Secretary of State may make regulations with respect to the provision of services in accordance with section 17C arrangements.

(2)The regulations must—

(a)include provision for participants other than Health Boards to withdraw from section 17C arrangements if they wish to do so;

(b)impose conditions (including conditions as to qualifications and experience) to be satisfied by medical practitioners performing personal medical services, and dental practitioners performing personal dental services, in accordance with section 17C arrangements.

In paragraph (b) “practitioner” does not include a practitioner who is undergoing training of a prescribed description.

(3)The regulations may, in particular—

(a)provide that section 17C arrangements may be made only in prescribed circumstances;

(b)provide that section 17C arrangements may be made only in prescribed areas;

(c)provide that only prescribed services, or prescribed categories of service, may be provided in accordance with section 17C arrangements;

(d)require details of section 17C arrangements to be published;

(e)make provision with respect to the variation and termination of section 17C arrangements;

(f)prevent (except in such circumstances and to such extent as may be prescribed) a medical practitioner who performs personal medical services in accordance with section 17C arrangements from providing general medical services;

(g)make provision with respect to medical lists, including provision for preferential treatment for medical practitioners;

(h)provide for parties to section 17C arrangements to be treated, in such circumstances and to such extent as may be prescribed, as health service bodies for the purposes of section 17A;

(i)provide for directions, as to payments, made under section 17A(8) (as it has effect as a result of regulations made by virtue of paragraph (h)) to be enforceable in like manner as extract registered decrees arbitral bearing warrant for execution issued by the sheriff court of any sheriffdom in Scotland;

(j)confer powers or impose duties on the Dental Practice Board in relation to agreements made by virtue of section 17C(1) under which personal dental services are provided;

(k)authorise [Strategic Health Authorities and] Health Boards to make payments of financial assistance for prescribed categories of preparatory work undertaken—

(i)in connection with preparing proposals for section 17C arrangements; or

(ii)in preparation for the provision of services under proposed section 17C arrangements.

(4)The regulations must include provision for a medical practitioner who—

(a)has provided or performed personal medical services in accordance with section 17C arrangements, and

(b)in contemplation of doing so, gave up fund-holding status,

to be allowed to return immediately to fund-holding status on satisfying the Secretary of State that, if he were granted that status, he would be able to fulfil the conditions for the time being in force for continuing to have it.

For the purposes of this subsection “fund-holding status” has such meaning as may be prescribed.

(5)The Secretary of State must—

(a)consider whether section 17C arrangements are likely to have an adverse effect on the distribution of medical practitioners providing general medical services or performing personal medical services in Scotland;

(b)if he thinks that the arrangements are likely to have that effect, consider whether it is necessary to include in the regulations provisions designed to secure that, so far as is possible, the arrangements do not have that effect; and

(c)if he thinks that it is necessary, include such provisions in the regulations.

F3(6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(7)Regulations made by virtue of subsection (3)(g) may, in particular, include provision—

(a)requiring (except in prescribed circumstances) Health Boards to remove from their medical lists persons who are performing personal medical services in accordance with section 17C arrangements or corresponding services under section 28C of the M4National Health Service Act 1977;

(b)conferring a right to transfer to a medical list on persons who have ceased to perform such services;

(c)that any provision in relation to medical lists made by or under any enactment is not to apply;

(d)as to conditions to be attached to entries in medical lists;

(e)conferring powers of disqualification on the Tribunal constituted under section 29.

(8)The power to make provision under this section of the kind mentioned in subsection (3)(j) includes power—

(a)to authorise or require the Dental Practice Board to perform on behalf of a Health Board functions of a prescribed description (including functions relating to remuneration) which have been delegated to the Dental Practice Board by the Health Board in accordance with a power conferred by the regulations;

(b)to provide that functions conferred by the regulations are only to be exercised by the Dental Practice Board in accordance with directions of the Secretary of State;

(c)to require information for the purpose of performing any functions conferred or imposed on the Dental Practice Board under this section.

(9)In this Act “section 17C arrangements” means arrangements for the provision of services made under section 17C.”

23 Right to choose medical practitioner.E+W+S

F4(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F5(2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24 Right to choose dental practitioner.E+W+S

F6(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 17F, insert—

“17G Right to choose dental practitioner.

(1)Provision shall be made in regulations for conferring a right on any person to choose the dental practitioner from whom he is to receive primary dental services, subject to the consent of the practitioner concerned.

(2)The regulations shall, in particular, prescribe the procedure for choosing a practitioner.

(3)The regulations may, in particular, provide that the right to choose a dental practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.

(4)In this section “primary dental services” means dental services which are—

(a)provided, in accordance with section 17C arrangements, as personal dental services; or

(b)provided under Part II as general dental services.”

25 Liabilities and obligations in relation to deputies.U.K.

F7(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 24, insert—

“24A Liabilities and obligations in relation to deputies.

(1)Regulations may make provision with respect to the liabilities and obligations of—

(a)a Part II practitioner who, in connection with any obligation of his to provide general medical services, enters into arrangements under which a Part I practitioner deputises, or is engaged to deputise, for him; or

(b)a Part II practitioner who enters into arrangements under which he deputises, or is engaged to deputise, for a Part I practitioner, in connection with that practitioner’s obligation to perform personal medical services in accordance with section 17C arrangements.

(2)The regulations may, in particular—

(a)modify any liabilities or obligations which would otherwise be applicable by virtue of this Part;

(b)apply (with or without modifications) any provision made by or under this Part (including any provision so made by virtue of section 17 of the M5Health and Medicines Act 1988).

(3)In subsection (1)—

• “Part I practitioner” means a medical practitioner who performs personal medical services in accordance with section 17C arrangements; and

• “Part II practitioner” means a medical practitioner who provides general medical services.”

Pharmaceutical servicesU.K.

27 Provision of additional pharmaceutical services.E+W+S

F9(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 27, insert—

“27A Arrangements for providing additional pharmaceutical services.

(1)The Secretary of State may—

(a)give directions to a Health Board requiring them to arrange for the provision to persons in their area of additional pharmaceutical services; or

(b)by giving directions to a Health Board authorise them to arrange for such provision if they wish to do so.

(2)Directions under this section may make different provision in relation to different services specified in the directions.

(3)The Secretary of State must publish any directions under this section in the Drug Tariff or in such other manner as he thinks appropriate.

(4)In this section—

• “additional pharmaceutical services”, in relation to directions, means such services (of a kind that do not fall within section 27) as may be specified in the directions; and

• “Drug Tariff” means the Drug Tariff published under regulation 9 of the M6National Health Service (Pharmaceutical Services) (Scotland) Regulations 1995 or under any corresponding provision replacing, or otherwise derived from, that regulation.”

28 Terms and conditions etc.E+W+S

F10(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 27A, insert—

“27B Terms and conditions etc.

(1)Directions under section 27A may require the Health Board to whom they apply, when making arrangements—

(a)to include, in the terms on which the arrangements are made, such terms as may be specified in the directions;

(b)to impose, on any person providing a service in accordance with the arrangements, such conditions as may be so specified.

(2)The arrangements must secure that any service to which they apply is provided only by a person whose name is included in a pharmaceutical list.

(3)Different arrangements may be made with respect to—

(a)the provision of the same service by the same person but in different circumstances; or

(b)the provision of the same service by different persons.

(4)A Health Board must provide details of proposed arrangements (including the remuneration to be offered for the provision of services) to any person who asks for them.

(5)After making any arrangements, a Health Board must publish, in such manner as the Secretary of State may direct, such details of the arrangements as he may direct.

(6)In this section, “pharmaceutical list” means, subject to any provision of the directions in question, a list—

(a)published by the Health Board concerned, or by any other Health Board, in accordance with regulations made under section 27(2) of this Act; or

(b)published by any body in accordance with regulations made under section 42(2) of the M7National Health Service Act 1977 or Article 63(2A)(a) of the M8Health and Personal Social Services (Northern Ireland) Order 1972.”

29 Authorised provision of pharmaceutical services by medical practitioners.E+W+S

F11(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In section 28 of the 1978 Act, after subsection (2), insert—

“(2A)Regulations shall provide for the preparation and publication by a Health Board of one or more lists of medical practitioners who undertake to supply drugs and appliances in the Board’s area.

(2B)The regulations shall include provision for the removal of an entry from a list in prescribed circumstances.”

Ophthalmic servicesU.K.

30 Duty of registered opticians to refer certain persons to registered medical practitioners.E+W+S

(1)Section 31 of the M9Opticians Act 1989 (matters with respect to which the General Optical Council may make rules) is amended as follows.

(2)In subsection (5) (power to make rules requiring registered optician to refer persons to registered medical practitioners except in certain circumstances), for the words from “except” to “take the prescribed steps” substitute “except—

(a)in an emergency,

(b)where that person is consulting him for the purpose of being given treatment in accordance with rules under subsection (l)(d) above, or

(c)in such other cases as may be prescribed,

take the prescribed steps ”.

(3)After subsection (5), insert—

“(5A)Rules made by virtue of subsection (5)(c) may impose conditions which must be satisfied if the exception for which those rules provide is to apply.”

NHS contractsE+W+S

31 Provision of certain services under NHS contracts.E+W+S

F12(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 17, insert—

“ NHS contractsE+W+S

17AA Provision of certain services under NHS contracts.

(1)This section applies to any arrangement under which a Health Board or such other health service body as may be prescribed arrange for the provision to them—

(a)by a person on an ophthalmic list, or

(b)by a person on a pharmaceutical list,

of goods or services that they reasonably require for the purposes of functions which they are exercising under Part I of this Act.

(2)Any such arrangement is to be treated as an NHS contract for the purposes of section 17A (other than subsections (5) and (7)).

(3)In this section—

• “health service body” means a person or body which is a health service body for the purposes of section 17A;

• “ophthalmic list” means a list published in accordance with regulations made under—

  (a)

  section 26(2)(a) of this Act;

  (b)

  section 39(a) of the M10National Health Service Act 1977; or

  (c)

  Article 62(2)(a) of the M11Health and Personal Social Services (Northern Ireland) Order 1972; and

• “pharmaceutical list” means a list published in accordance with regulations made under—

  (a)

  section 27(2) of this Act;

  (b)

  section 42(2)(a) of the National Health Service Act 1977; or

  (c)

  Article 63(2A)(a) of the 1972 Order.”

Medical lists and vacanciesU.K.

F1332 Medical lists and vacancies: England and Wales.E+W+S

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical practicesU.K.

34 Sale of medical practices.E+W+S

F15(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, for section 35 (sale of medical practices), substitute—

“35 Sale of medical practices.

(1)It is unlawful to sell the goodwill of the medical practice of a person who has at any time—

(a)provided general medical services under arrangements made with any Executive Council or Health Board under the M12National Health Service (Scotland) Act 1947, the M13National Health Service (Scotland) Act 1972 or this Act, or

(b)provided or performed personal medical services in accordance with section 17C arrangements,

unless that person no longer provides or performs such services and has never carried on the practice in a relevant area.

(2)In this section—

• “goodwill” includes any part of goodwill and, in relation to a person practising in partnership, means his share of the goodwill of the partnership practice;

• “medical practice” includes any part of a medical practice; and

• “relevant area”, in relation to any Executive Council or Health Board by arrangement with whom a person has at any time—

  (a)

  provided general medical services, or

  (b)

  provided or performed personal medical services in accordance with section 17C arrangements,

  means the area of that Council or Board (at that time).

(3)Schedule 9 supplements the provisions of this section.”

35 Employment of pre-registration house officers in medical practices.E+W+S

(1)The M14Medical Act 1983 is amended as follows.

(2)In subsection (2) of section 10 (experience required for full registration as a medical practitioner), for “approved hospitals or approved institutions,” substitute “—

(a)approved hospitals,

(b)approved institutions, or

(c)approved medical practices,”.

(3)In subsection (3) of section 11 (construction of section 10, etc), after the first “where” insert “—

(a)in the case of an approved hospital or an approved institution,”, and at the end insert

“; or

(b)in the case of an approved medical practice, the person employed satisfies such conditions as to residence as may be prescribed”.

(4)In subsection (4) of section 11—

(a)insert in the appropriate place—

““medical practice” means a prescribed description of practice in which one or more medical practitioners—

(a)provide general medical services under Part II of the M15National Health Service Act 1977, Part II of the M16National Health Service (Scotland) Act 1978 or Part VI of the M17Health and Personal Social Services (Northern Ireland) Order 1972; or

(b)perform personal medical services in accordance with arrangements made under section 28C of the 1977 Act, section 17C of the 1978 Act or the corresponding provisions of the law in force in Northern Ireland;”;

(b)in the definition of “prescribed”, after “means” insert “—

(a)in subsection (3)(b) and in the definition of “medical practice”, prescribed by regulations made by the Secretary of State; and

(b)in the other provisions of this Part,”.

(5)After subsection (4) of section 11 insert—

“(4A)The Education Committee may by regulations provide that the period of employment in a medical practice which may be reckoned towards the completion of any of the periods mentioned in section 10(3)(a) above shall not exceed such period as may be specified in the regulations.”

(6)In subsection (5) of section 11, after “under subsection (2) of section 10 above” insert “ or under subsection (4A) of this section ”.

(7)After subsection (6) of section 11 insert—

“(7)Regulations made by the Secretary of State under this section must be made by statutory instrument; and such a statutory instrument shall be subject to annulment in pursuance of a resolution of either House of Parliament.”