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

Explanatory Note

(This note is not part of the Regulations)

These Regulations further amend the National Health Service (General Medical and Pharmaceutical Services) Regulations 1974 (“the principal Regulations”) which regulate the terms on which general medical and pharmaceutical services are provided under the National Health Service Act 1977 (“the 1977 Act”)

Regulation 3 of the principal Regulations is amended to include child health surveillance services (set out in a new Schedule 1A) and minor surgery services (set out in a new Schedule 1B) among the services provided by medical practioners (“doctors”) in pursuance of arrangements made by a Family Practitioner Committee (“the Committee”) (regulation 3), and new regulations 3A and 3B are inserted to make provision for each Committee to compile and maintain lists of the doctors providing child health surveillance services and minor surgery services in its locality (regulation 4). New Parts IV and V are inserted into Schedule 1 to the principal Regulations (by Schedule 3 to these Regulations) to specify the information to be provided by a doctor applying for the inclusion of his name in, respectively, the child health surveillance list or the minor surgery list.

Amendments are made to require a Committee to record additional information on the list (“the medical list”) it maintains of doctors providing general medical services (regulation 5), and regarding the circumstances in which a doctor’s name may be removed from a medical list (regulation 6). A new regulation 5A is inserted in the principal Regulations to require each Committee to compile and maintain a Local Directory of Family Doctors (“the Local Directory”) in relation to those doctors whose names are included in its medical list, and to oblige doctors to supply certain information to the Committee for the purpose of the Local Directory. A new regulation 5B is also inserted to make provision for the removal of a doctor’s name from any medical list when he attains the age of 70 (regulation 7). Further amendments in connection with the medical list and the Local Directory are made, respectively, by regulations 8 and 9. The forms which must be used by doctors when applying to have their names included in a medical list or to succeed to a practice declared vacant are replaced by a specified list of particulars to be included in an application (Schedule 2 to these Regulations).

Regulation 11 makes provision for a patient’s application to a doctor for the provision of child health surveillance services or minor surgery services and consequential amendments are made to govern the provision of such services, in circumstances where, respectively, a patient is assigned by a Committee to a doctor’s list or where a doctor is providing temporary medical services to a patient (regulations 12 and 15). Regulations 14 and 16 of these Regulations simplify the procedure whereby a patient may change the doctor who is providing, respectively, any general medical services or only maternity medical services. Regulation 17 of these Regulations amends the provision for the remuneration of doctors providing general medical services, and amendments made by regulation 19 provide for the publication by a Committee of its Local Directory and of doctors' practice leaflets. Transitional provision is made (in regulation 24) in respect of any doctor whose claim for fees or allowances earned before the date from which the amendments relating to doctor’s remuneration come into force is not determined until after that date.

Schedule 1 to these Regulations amends the “terms of service” under which doctors provide general medical services to their patients. Paragraph 3 of those terms of service is amended to make provision for the standard of skill, knowledge and care to be expected from doctors providing child health surveillance services and minor surgery services, and an amendment is made to the definition of a doctor’s patients in paragraph 4 to include those persons to whom he provides such services. New paragraphs 9A, 9B, 9C and 12A of the terms of service and new Schedules 1A and 1B to the principal Regulations are inserted to make detailed provision for the nature and application of child health surveillance services and minor surgery services, and new paragraphs 13 to 13D of the terms of service are inserted to provide, generally and in relation to particular classes of patient, for the nature of the services a doctor must provide. In particular, a doctor is, in addition to his general obligations, required to offer a consultation to newly registered patients (new paragraph 13B), to patients whom he has not seen within the preceding 3 years (new paragraph 13C) and to patients who have attained the age of 75 (new paragraph 13D).

Paragraph 15 of the terms of service is amended to provide that a doctor is at all times responsible for the provision of general medical services to his patients, while enabling those doctors who have before 1st April 1990 been relieved by the Committee of such responsibility at certain times to continue to enjoy such relief after that date. An amendment is made in paragraph 16 in connection with the employment of assistants and deputies by doctors when providing child health surveillance services or minor surgery services. A new paragraph 24A is inserted in the terms of service to require a doctor to satisfy himself as to the suitability and competence of prospective employees, having regard in particular to any guidance to doctors by the Committee under the new regulation 33B in the principal Regulations (inserted by regulation 20).

A new paragraph 25 is substituted in the terms of service to require a doctor to obtain the approval of the Committee for the times and places at which he proposes to be available for consultation by his patients, and new paragraphs 25A, 25B, 25C and 25D are also inserted to make provision for the circumstances in which, and the extent to which, a Committee may approve a proposal by a doctor to be available for fewer hours, or on fewer days, in each week than are specified in the new paragraph 25. A new Schedule 1C is inserted in the principal Regulations to specify the information to be included in applications by doctors for the purposes of paragraph 25.

A new paragraph 29A is inserted in the terms of service requiring a doctor to notify the Committee of any change in his place of residence, and paragraph 42 is amended to enable an ophthalmic doctor to demand or accept a fee or remuneration for testing the sight of a patient. A new paragraph 38B is inserted to oblige a doctor to produce annually, and to make available to the Committee, to his patients and to certain other persons, a practice leaflet which must include certain information (specified in a new Schedule 1D) about the personal medical services he provides. New paragraph 39A requires a doctor to answer enquiries made by a Committee’s medical adviser (appointed in accordance with new regulation 33A) in connection with his prescribing of drugs and appliances for his patients and his referral of them to other services provided under the 1977 Act. A new paragraph 43A also obliges a doctor to provide annually to the Committee a report which must include certain information (specified in a new Schedule 1E) about his practice.

Regulation 18 of these Regulations amends regulation 25(3) of the principal Regulations which defines the supplemental services which can be provided as part of pharmaceutical services. Regulation 23 removes one substance from, and includes other drugs and substances in, Schedule 3A to the principal Regulations, which contains a list of drugs and other substances which may not be prescribed for supply, and which may not be dispensed, in the course of pharmaceutical services provided under the 1977 Act.

These Regulations also effect consequential amendments in the principal Regulations arising out of and in connection with the changes mentioned above.