General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1996

Amendment of Schedule 1 to the principal regulations

8.—(1) Schedule 1 to the principal regulations (terms of service for doctors) shall be amended as follows.

(2) In paragraph 1, at the beginning, there shall be inserted the following definition—

““notice” means notice in writing;”.

(3) In paragraph 3 (persons for whose treatment a doctor is responsible), in sub-paragraph (1)—

(a) at the end of head (h) there shall be inserted—

“and

(i) any person for whom he has accepted responsibility under an arrangement made under paragraph 14BB(2).”.

(4) After sub-paragraph (5) of paragraph 11 there shall be inserted the following sub-paragraph—

“(6) A doctor who is authorised or required by a Board under regulation 41 to provide drugs or appliances to a patient or who otherwise provides pharmaceutical services shall secure that the practice based complaints procedure he has established and operates in accordance with paragraph 11B applies in relation to any matter reasonably connected with his provision of pharmaceutical services as it applies as respects his provision of general medical services. Accordingly, paragraph 11C also applies in relation to complaints about such matters.”.

(5) After paragraph 11A (practice leaflet), there shall be inserted the following new paragraphs—

“Complaints

11B.— (1) Subject to sub-paragraph (2), a doctor shall establish, and operate in accordance with this paragraph, a procedure (in this paragraph and in paragraph 11C referred to as a “practice based complaints procedure”) to deal with any complaints made by or on behalf of his patients and former patients.

(2) The practice based complaints procedure to be established by a doctor may be such that it also deals with complaints made in relation to one or more other doctors.

(3) A practice based complaints procedure shall apply to complaints made in relation to any matter reasonably connected with the doctor’s provision of general medical services and within the responsibility or control of—

(a) the doctor;

(b) any other doctor either employed by him or engaged as his deputy;

(c) a former partner of the doctor;

(d) an employee of the doctor other than one falling within head (b),

and in this paragraph and paragraph 11C, references to complaints are to complaints falling within this sub-paragraph.

(4) A complaint may be made on behalf of a patient or former patient with his consent, or

(a) where the patient is a child—

(i) by either parent, or in the absence of both parents, the guardian or other adult person who has care of the child, or

(ii) where the child is in the care of a Board or HSS trust to whose care he has been committed under the provisions of the Children and Young Persons Act (Northern Ireland) 1968(1), by a person duly authorised by that Board or trust, or

(iii) where the child is in the care of a voluntary organisation, by that organisation or a person duly authorised by it, or

(iv) where the child is in a training school, by the Manager of that training school; or

(b) where the patient is incapable of making a complaint, by a relative or other adult person who has an interest in his welfare.

(5) Where a patient has died a complaint may be made by a relative or other adult person who had an interest in his welfare or, where the patient was as described in head (a) (ii), (iii) or (iv) of sub-paragraph (4), by the Board or HSS trust, or voluntary organisation, or the manager of the training school.

(6) A practice based complaints procedure shall comply with the following requirements—

(a) the doctor must specify a person (who need not be connected with the practice and who, in the case of an individual, may be specified by his job title) to be responsible for receiving and investigating all complaints;

(b) all complaints must be—

(i) recorded in writing,

(ii) acknowledged, either orally or in writing, within the period of 3 days (excluding Saturdays, Sundays, and Bank and Public Holidays) beginning with and including the day on which the complaint was made or, where that is not possible, as soon as reasonably practicable, and

(iii) properly investigated;

(c) within the period of 10 days (excluding Saturdays, Sundays, and Bank and Public Holidays) beginning with and including the day on which the complaint was received by the person specified under head (a) or, where that is not possible, as soon as reasonably practicable, the complainant must be given a written summary of the investigation and its conclusions;

(d) where the investigation of the complaint requires consideration of the patient’s medical records, the person specified under head (a) must inform the patient or person acting on his behalf if the investigation will involve disclosure of information contained in those records to a person other than the doctor or a partner, a deputy or an employee of the doctor; and

(e) the doctor must keep a record of all complaints and copies of all correspondence relating to complaints, but such records must be kept separate from patients' medical records.

(7) A doctor shall inform his patients about the practice based complaints procedure which he operates and the name (or title) of the person specified under sub-paragraph (6)(a).

11C.— (1) A doctor shall co-operate with any investigation of a complaint by the Board in accordance with the procedures which it operates in accordance with directions given under Article 17(1) of the Order, whether the investigation follows one under the practice based complaints procedure or not.

(2) The co-operation required by sub-paragraph (1) includes—

(a) answering questions reasonably put to the doctor by the Board;

(b) providing any information relating to the complaint reasonably required by the Board; and

(c) attending any meeting to consider the complaint (if held at a reasonably accessible place and at a reasonable hour, and due notice has been given), if the doctor’s presence at the meeting is reasonably required by the Board.”.

(6) In paragraph 14 (deputies, assistants and partners), in sub-paragraph (1), after “Subject to sub-paragraphs (1)(a), (2), (2A) and (2B)” there shall be inserted “and to any out of hours arrangement made under paragraph 14BB(2)”.

(7) In paragraph 14B (duration of doctor’s responsibility), at the beginning there shall be inserted “Subject to paragraph 14BB”.

(8) After paragraph 14B (duration of doctor’s responsibility) there shall be inserted the following paragraphs—

“Out of hours arrangements

14BB.— (1) In this paragraph and in paragraph 14BC—

(a) “out of hours period” means—

(i) the period beginning at 7 pm on Mondays to Fridays and ending at 8 am the following day,

(ii) the period between 1 pm on Saturday and 8 am on the following Monday, and

(iii) Bank and Public Holidays;

and “part of an out of hours period” means any part of any one or more of the periods described in sub-heads (i) to (iii);

(b) “out of hours arrangement” means an arrangement under sub-paragraph (2); and

(c) “transferee doctor” means a doctor who has undertaken to carry out the obligations of another doctor under these terms of service during part or all of the out of hours period in accordance with an out of hours arrangement.

(2) Subject to sub-paragraphs (3) to (15), a doctor may, with the approval of the Board, make an arrangement with a doctor who is on the medical list to transfer his obligations under the terms of service during part or all of the out of hours period to that other doctor.

(3) A doctor may make more than one out of hours arrangement; and may do so (for example) with different transferee doctors and in respect of different patients, different times and different parts of his practice area.

(4) A doctor may retain responsibility for or make separate out of hours arrangements in respect of the provision of maternity medical services to patients with whom he has made an arrangement under regulation 28.

(5) Nothing in this paragraph prevents a doctor from retaining or resuming his obligations in relation to named patients.

(6) Where a doctor is on the obstetric list, he shall not make an out of hours arrangement in respect of the provision of maternity medical services to patients with whom he has made an arrangement under regulation 28 unless the transferee doctor is also on the obstetric list.

(7) An application to the Board for approval shall be made in writing and shall state—

(a) the name and address of the proposed transferee doctor, and the number of patients on his list;

(b) the periods during which the doctor’s obligations under these terms of service are to be transferred;

(c) how the proposed transferee doctor intends to meet the doctor’s obligations during the periods specified under head (b);

(d) the arrangements for the transfer of the doctor’s obligations under these terms of service to and from the transferee doctor at the beginning and end of the periods specified under head (b);

(e) whether the proposed arrangement includes the doctor’s obligations in respect of maternity medical services;

(f) how long the proposed arrangements are intended to last and the circumstances in which the doctor’s obligations under these terms of service during the periods specified under head (b) would revert to him;

(g) what arrangements are proposed to enable the doctor’s patients to contact the proposed transferee doctor; and

(h) whether the proposed transferee doctor—

(i) has been notified under regulation 7(4) of the Tribunal Regulations (Northern Ireland) 1995(2) that the Tribunal intends to hold an inquiry under paragraph 1 of Schedule 11 to the Order as to representations made in relation to him; or

(ii) has been notified under section 42(5) of the Medical Act 1983(3) that the Preliminary Proceedings Committee of the General Medical Council has decided that he should be referred to the Professional Conduct Committee or to the Health Committee.

(8) A Board shall determine the application before the end of the period of 28 days beginning with and including the day on which the Board received it.

(9) A Board shall grant approval to a proposed out of hours arrangement if it is satisfied—

(a) having regard in particular to the interests of the doctor’s patients, that the arrangement is reasonable;

(b) having regard in particular to all reasonably foreseeable circumstances, that the arrangement is practicable and will work satisfactorily;

(c) that it will be clear to the doctor’s patients how to seek personal medical services during the out of hours period; and

(d) that if the arrangement comes to an end, the doctor has in place proper arrangements for the immediate resumption of his responsibilities;

and shall not refuse to grant approval without first consulting the Local Medical Committee.

(10) The Board shall give notice to the doctor of its determination and, where it refuses an application, it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (11).

(11) A doctor may, before the end of the period of 30 days beginning with and including the day on which the Board’s notification under sub-paragraph (10) was sent, appeal in writing to the Department against any refusal of an application under sub-paragraph (7).

(12) The Department may, when determining an appeal, either confirm the determination of the Board or substitute its own determination for that of the Board.

(13) The Department shall give notice to the doctor of its determination and shall in every case include with the notification a written statement of the reasons for the determination.

(14) Where the Board (or, on appeal, the Department) has approved an out of hours arrangement—

(a) the transferee doctor may himself employ or engage an assistant or deputy in respect of part or all of the period covered by the out of hours arrangement; and if he does so, paragraph 14 shall apply as if he were the doctor for the purposes of that paragraph; and

(b) a transferee doctor shall not enter into any other out of hours arrangement in respect of the patients for whom he has accepted responsibility under this paragraph.

14BC.— (1) Subject to paragraph 14BD, where it appears to the Board that it may no longer be satisfied with any of the matters referred to in sub-paragraphs (a) to (d) of paragraph 14BB(9), it may give notice in writing to the doctor that it proposes to review the approval.

(2) On any review under sub-paragraph (1), the Board shall allow the doctor a period of 30 days, beginning with and including the day on which it sent the notice, within which to make representations in writing to the Board.

(3) After considering any representations made in accordance with sub-paragraph (2), the Board may determine either to continue or to withdraw its approval but shall not withdraw its approval without first consulting the Local Medical Committee.

(4) The Board shall give notice to the doctor of a determination under sub-paragraph (3).

(5) Where the Board withdraws its approval, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (6).

(6) A doctor may, within the period of 30 days beginning with and including the day on which the notice referred to in sub-paragraph (4) was sent, appeal in writing to the Department against the withdrawal of approval and sub-paragraphs (12) and (13) of paragraph 14BB shall apply to any such appeal.

(7) Subject to paragraph 14BD(1), where the Board withdraws approval, the withdrawal shall not take effect until the end of the period of 2 months beginning with and including the date on which the notice referred to in sub-paragraph (4) was sent or where there is an appeal under sub-paragraph (6) and the appeal is dismissed, the date on which the doctor receives notice of the dismissal of the appeal, whichever is the later.

14BD.— (1) Where it appears to the Board, whether after a review under paragraph 14BC or not, that it is necessary in the interests of the doctor’s patients to withdraw its approval immediately, it may withdraw its approval.

(2) The Board shall give notice to the doctor of a determination under sub-paragraph (1) and shall include with the notice a statement of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (4).

(3) An immediate withdrawal of approval under sub-paragraph (1) shall take effect on the day on which the notice referred to in sub-paragraph (2) is received by the doctor.

(4) A doctor may, within the period of 30 days beginning with and including the day on which the notice referred to in sub-paragraph (2) was sent, appeal in writing to the Department against the withdrawal of approval and sub-paragraphs (12) and (13) of paragraph 14BB shall apply to any such appeal.”.

(1)

1968 c. 34

(2)

S.R. 1995 No. 493

(3)

1983 c. 54