The National Health Service (General Medical Services Contracts) (Wales) Regulations 2023

Prospective

PART 6 E+W Persons who perform services

Qualifications of performers: medical practitioners E+W

61.—(1) Subject to sub-paragraph (2), no medical practitioner may perform medical services under the contract unless the medical practitioner is—

(a) included in a medical performers’ list for a Local Health Board in Wales,

(b) not suspended from that list or from the Medical Register, and

(c) not subject to interim suspension under section 41A of the Medical Act 1983 (interim order).

(2) Sub-paragraph (1) does not apply to any medical practitioner who is an exempt medical practitioner within the meaning of sub-paragraph (3) but only in so far as any medical services that the medical practitioner performs constitute part of a post-registration programme.

(3) For the purposes of this paragraph, an “exempt medical practitioner” is—

(a) a medical practitioner employed by an NHS trust(1), an NHS foundation trust(2), a Health Board, or a Health and Social Care Trust who is providing services other than primary medical services at the practice premises,

(b) a person who is provisionally registered under section 15 (provisional registration), 15A (provisional registration for EEA nationals) or 21 (provisional registration) of the Medical Act 1983 and who is acting in the course of the person’s employment in a resident medical capacity,

(c) a GP Specialty Registrar who has applied to a Local Health Board to have their name included in its medical performers list until the first of the following events arises—

(i) the Local Health Board notifies the GP Specialty Registrar of its decision on that application, or

(ii) the end of a period of 12 weeks, starting with the date on which that GP Specialty Registrar begins a postgraduate medical education and training scheme necessary for the award of a Certificate of Completion of Training,

(d) a medical practitioner who is already included in the medical performers list of another primary care organisation and who has submitted an application to a Local Health Board in accordance with regulation 4A of the National Health Service (Performers Lists) (Wales) Regulations 2004 until the first of the following events arises—

(i) the Local Health Board notifies the medical practitioner of its decision on that application, or

(ii) the end of a period of 12 weeks, starting with the date on which the application was submitted, or

(e) a medical practitioner, who—

(i) is not a GP Specialty Registrar,

(ii) is undertaking a post-registration programme of clinical practice supervised by the General Medical Council,

(iii) has notified the Local Health Board that they are to undertake part or all of a post-registration programme in its area at least 24 hours before commencing any part of that programme taking place in the Local Health Board’s area, and

(iv) has, with that notification, provided the Local Health Board with evidence sufficient for it to satisfy itself that they are undertaking a post-registration programme,

but only in so far as any medical services that the medical practitioner performs constitute part of a post-registration programme.

Commencement Information

I1 Sch. 3 para. 61 in force at 1.10.2023, see reg. 1(2)

Qualifications of performers: health care professionals E+W

62.  A health care professional (other than one to whom paragraph 61 applies) may not perform clinical services under the contract unless—

(a) that person is registered with the professional body relevant to that person’s profession, and

(b) that registration is not subject to a period of suspension.

Commencement Information

I2 Sch. 3 para. 62 in force at 1.10.2023, see reg. 1(2)

Conditional registration or inclusion in primary care list E+W

63.  Where the registration of a health care professional or, in the case of a medical practitioner, the medical practitioner’s inclusion in a primary care list is subject to conditions, the contractor must ensure compliance with those conditions insofar as they are relevant to the contract.

Commencement Information

I3 Sch. 3 para. 63 in force at 1.10.2023, see reg. 1(2)

Clinical experience E+W

64.  No health care professional may perform any clinical services unless the health care professional has such clinical experience and training as are necessary to enable the health care professional properly to perform such services.

Commencement Information

I4 Sch. 3 para. 64 in force at 1.10.2023, see reg. 1(2)

Conditions for employment and engagement: medical practitioner E+W

65.—(1) Subject to sub-paragraphs (2) to (4), a contractor must not employ or engage a medical practitioner (other than an exempt medical practitioner within the meaning of sub-paragraph 61(3)) unless—

(a) that practitioner has provided the contractor with the name and address of the Local Health Board on whose medical performers list the practitioner appears, and

(b) the contractor has checked that the practitioner meets the requirements in paragraph 61.

(2) Where—

(a) the employment or engagement of a medical practitioner is urgently needed, and

(b) it is not possible for the contractor to check that the medical practitioner meets the requirements referred to in paragraph 61 before employing or engaging the health care professional,

the contractor may employ or engage the medical practitioner on a temporary basis for a single period of up to 7 days while such checks are undertaken.

(3) Where the prospective employee is a GP Specialty Registrar, the requirements set out in sub-paragraph (1) apply with the modifications that—

(a) the name and address provided under sub-paragraph (1) may be the name and address of the Local Health Board on whose list the GP Specialty Registrar has applied for inclusion, and

(b) confirmation that the GP Specialty Registrar’s name appears on that list is not to be required until the end of the first 12 weeks of the GP Specialty Registrar’s training period.

(4) Where the prospective employee is a medical practitioner who is already included in the medical performers list of another primary care organisation and who has submitted an application to the Local Health Board in accordance with regulation 4A of the National Health Service (Performers Lists) (Wales) Regulations 2004, the requirements set out in sub-paragraph (1) apply with the modifications that—

(a) the name and address provided under sub-paragraph (1) may be the name and address of the Local Health Board on whose list the medical practitioner has applied for inclusion, provided that the name and address of the primary care organisation on whose list the medical practitioner is already included is provided in addition; and

(b) confirmation that the medical practitioner’s name appears on that list means confirmation that the medical practitioner is provisionally included in the Local Health Board’s medical performers list in accordance with regulation 4A of the National Health Service (Performers Lists) (Wales) Regulations 2004.

(5) In this paragraph “primary care organisation” has the meaning given in regulation 2 of the National Health Service (Performers Lists) (Wales) Regulations 2004.

Commencement Information

I5 Sch. 3 para. 65 in force at 1.10.2023, see reg. 1(2)

Conditions for employment or engagement: health care professionals E+W

66.—(1) Subject to paragraph (2), a contractor may not employ or engage a health care professional to perform clinical services under the contract unless—

(a) the contractor has checked that the health care professional meets the requirements of paragraph 62, and

(b) the contractor has taken reasonable steps to satisfy itself that the health care professional meets the requirements of paragraph 64.

(2) Where—

(a) the employment or engagement of a health care professional is urgently needed, and

(b) it is not possible for the contractor to check that the health care professional meets the requirements referred to in paragraph 62 before employing or engaging the health care professional,

the contractor may employ or engage the health care professional on a temporary basis for a single period of up to 7 days while such checks are undertaken.

(3) When considering a health care professional’s experience and training for the purposes of paragraph (1)(b), the contractor must, in particular, have regard to—

(a) any post-graduate or post-registration qualification held by the health care professional, and

(b) any relevant training undertaken, and any relevant clinical experience gained, by the health care professional.

Commencement Information

I6 Sch. 3 para. 66 in force at 1.10.2023, see reg. 1(2)

Clinical references E+W

67.—(1) The contractor may not employ or engage a health care professional to perform clinical services under the contract (other than an exempt medical practitioner to whom paragraph 61(3)(e) applies) unless—

(a) that person has provided two clinical references, relating to two recent posts (which may include any current post) as a health care professional which lasted for at least 12 weeks without a significant break or, where this is not possible, a full explanation of why this is the case and details of alternative referees, and

(b) the contractor has checked and is satisfied with the references.

(2) Where—

(a) the employment or engagement of a health care professional is urgently needed, and

(b) it is not possible for the contractor to obtain and check the references in accordance with sub-paragraph (1)(b) before employing or engaging that health care professional,

the contractor may employ or engage the health care professional on a temporary basis for a single period of up to 14 days while the references are checked and considered, and for an additional period of a further 7 days if the contractor believes that the person supplying those references is ill, on holiday or otherwise temporarily unavailable.

(3) Where the contractor employs or engages the same person on more than one occasion within a period of 12 weeks, the contractor may rely on the references provided on the first occasion, provided that those references are not more than a year old.

Commencement Information

I7 Sch. 3 para. 67 in force at 1.10.2023, see reg. 1(2)

Verification of qualifications and competence E+W

68.—(1) The contractor must, before employing or engaging any person—

(a) comply with the Pre-employment Checks Standards in relation to that person, and

(b) take reasonable steps to satisfy itself that the person in question is both suitably qualified and competent to discharge the duties for which that person is to be employed or engaged.

(2) The duty imposed by sub-paragraph (1) is in addition to the duties imposed by paragraphs 61 to 67.

(3) When considering the competence and suitability of any person for the purpose of sub-paragraph (1), the contractor must have regard, in particular, to—

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

(b) that person’s education and training, and

(c) that person’s previous employment or work experience.

Commencement Information

I8 Sch. 3 para. 68 in force at 1.10.2023, see reg. 1(2)

Training E+W

69.—(1) The contractor must ensure that for any health care professional who is—

(a) performing clinical services under the contract, or

(b) employed or engaged to assist in the performance of such services,

there are in place arrangements for the purpose of maintaining and updating the health care professional’s skills and knowledge in relation to the services which they are performing or assisting in performing.

(2) The contractor must afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee’s competence.

Commencement Information

I9 Sch. 3 para. 69 in force at 1.10.2023, see reg. 1(2)

Terms and conditions E+W

70.  The contractor may only offer employment to a general medical practitioner on terms and conditions which are no less favourable than those contained in the “Model terms and conditions of service for a salaried general practitioner employed by a GMS practice” published by the British Medical Association and the NHS Confederation as item 1.2 of the supplementary documents to the GMS contract 2003(3).

Commencement Information

I10 Sch. 3 para. 70 in force at 1.10.2023, see reg. 1(2)

Arrangements for GP Specialty Registrars E+W

71.—(1) The contractor may only employ a GP Specialty Registrar subject to the conditions in sub-paragraph (2).

(2) The conditions referred to in sub-paragraph (1) are that the contractor must not, by reason only of having employed or engaged a GP Specialty Registrar, reduce the total number of hours that other medical practitioners perform primary medical services under the contract or that other staff spend assisting them in the performance of those services.

(3) A contractor employing a GP Registrar must—

(a) offer the GP Registrar terms of employment in accordance with the rates and subject to the conditions contained in any directions given by Welsh Ministers to Local Health Boards under section 12 of the Act (Functions of Local Health Board) concerning the grants, fees, travelling and other allowances payable to GP Registrars, and

(b) take into account the guidance contained in the document entitled “A Reference Guide For Postgraduate Foundation and Specialty Training in the UK”(4).

Commencement Information

I11 Sch. 3 para. 71 in force at 1.10.2023, see reg. 1(2)

Notice requirements in respect of relevant prescribers E+W

72.—(1) For the purposes of this paragraph, “a relevant prescriber” is—

(a) an independent nurse prescriber,

(b) a nurse independent prescriber,

(c) a paramedic independent prescriber,

(d) a pharmacist independent prescriber,

(e) a physiotherapist independent prescriber,

(f) a podiatrist or chiropodist independent prescriber,

(g) a supplementary prescriber, or

(h) a therapeutic radiographer independent prescriber.

(2) The contractor must give notice to the Local Health Board where—

(a) a relevant prescriber is employed or engaged by a contractor to perform functions which include prescribing,

(b) a relevant prescriber whose functions include prescribing is a party to the contract, or

(c) the functions of a relevant prescriber whom the contractor already employs or has already engaged are extended to include prescribing.

(3) The notice under sub-paragraph (2) must be given in writing to the Local Health Board before the expiry of the period of 7 days beginning with the date on which—

(a) the relevant prescriber was employed or engaged by the contractor or, as the case may be, became a party to the contract (unless, immediately before becoming such a party, paragraph (2)(a) applied to that relevant prescriber), or

(b) the functions of the relevant prescriber were extended to include prescribing.

(4) The contractor must give notice to the Local Health Board where—

(a) the contractor ceases to employ or engage a relevant prescriber in the contractor’s practice whose functions include prescribing in the contractor’s practice,

(b) a relevant prescriber ceases to be a party to the contract,

(c) the functions of a relevant prescriber employed or engaged by the contractor in the contractor’s practice are changed so that they no longer include prescribing in the contractor’s practice, or

(d) the contractor becomes aware that a relevant prescriber whom it employs or engages has been removed or suspended from the relevant register.

(5) The notice under sub-paragraph (4) must be given in writing to the Local Health Board before the end of the second working day after the day on which an event described in sub-paragraphs (4)(a) to (d) occurred in relation to the relevant prescriber.

(6) The contractor must provide the following information when it gives notice to the Local Health Board in accordance with sub-paragraph (2)—

(a) the person’s full name,

(b) the person’s professional qualifications,

(c) the person’s identifying number which appears in the relevant register,

(d) the date on which the person’s entry in the relevant register was annotated to the effect that the person was qualified to order drugs, medicines and appliances for patients,

(e) the date on which—

(i) the person was employed or engaged (if applicable),

(ii) the person became a party to the contract (if applicable), or

(iii) the functions of the person were extended to include prescribing in the contractor’s practice.

(7) The contractor must provide the following information when it gives notice to the Local Health Board in accordance with sub-paragraph (4)—

(a) the person’s full name,

(b) the person’s professional qualifications,

(c) the person’s identifying number which appears in the relevant register,

(d) the date on which—

(i) the person ceased to be employed or engaged in the contractor’s practice,

(ii) the person ceased to be a party to the contract,

(iii) the functions of the person were changed so as to no longer include prescribing in the contractor’s practice, or

(iv) the person was removed or suspended from the relevant register.

Commencement Information

I12 Sch. 3 para. 72 in force at 1.10.2023, see reg. 1(2)

Signing of documents E+W

73.—(1) The contractor must ensure—

(a) that the documents specified in sub-paragraph (2) include—

(i) the clinical profession of the health care professional who signed the document, and

(ii) the name of the contractor on whose behalf the document is signed, and

(b) that the documents specified in sub-paragraph (3) include the clinical profession of the health care professional who signed the document.

(2) The documents specified in this sub-paragraph are—

(a) certificates issued in accordance with regulation 19, unless regulations relating to particular certificates provide otherwise, and

(b) any other clinical documents apart from—

(i) home oxygen order forms, and

(ii) the documents specified in sub-paragraph (3).

(3) The documents specified in this paragraph are batch issues, prescription forms and repeatable prescriptions.

(4) This paragraph is in addition to any other requirements relating to the documents specified in sub-paragraphs (2) and (3) whether in these Regulations or elsewhere.

Commencement Information

I13 Sch. 3 para. 73 in force at 1.10.2023, see reg. 1(2)

Level of skill and compliance with pathways E+W

74.  The contractor must, and the contractor must ensure that those it employs or engages must—

(a) carry out the contractor’s obligations under the contract with reasonable care and skill, and

(b) consider the application of national condition pathways relevant for each patient.

Commencement Information

I14 Sch. 3 para. 74 in force at 1.10.2023, see reg. 1(2)

Appraisal and assessment E+W

75.—(1) The contractor must ensure that any medical practitioner performing services under the contract—

(a) participates in the appraisal system provided by the Local Health Board unless that medical practitioner participates in an appropriate appraisal system provided by another health service body or is an armed forces GP, and

(b) co-operates with the Local Health Board in relation to the Local Health Board’s patient safety functions.

(2) The Local Health Board must provide an appraisal system for the purposes of sub-paragraph (1)(a) after consultation with the Local Medical Committee (if any) for the area in which the practitioner provides services under the contract and such other persons as appear to it to be appropriate.

(3) In paragraph (1), “armed forces GP” means a medical practitioner who is employed on a contract of service by the Ministry of Defence, whether or not as a member of the armed forces of the Crown.

Commencement Information

I15 Sch. 3 para. 75 in force at 1.10.2023, see reg. 1(2)

(1)

Established under section 25 of the National Health Service Act 2006 (c. 41).

(2)

Established under section 30 of the National Health Service Act 2006 (c. 41).

(3)

This document is available at: https://www.nhsemployers.org/system/files/2021-06/TCS-GP-GMS-150409.pdf. Hard copies may be requested from The British Medical Association, BMA House, Tavistock Square, London WC1H 9JP.

(4)

This guidance, last published in August 2022, is available on request from Health Education and Improvement Wales, in hard copy by writing to HEIW, Tŷ Dysgu, Cefn Coed, Nantgarw, CF15 7QQ or via email to [e-mail].