The Health and Personal Social Services (General Medical Services Contracts) Regulations (Northern Ireland) 2004

Assignments to closed lists: dispute resolution procedure relating to determinations of the assessment panel

36.—(1) Where an assessment panel makes a determination under paragraph 35(7) that the Board may assign new patients to contractors which have closed their lists of patients, any contractor specified in that determination may refer the matter to the Department to review the determination of the assessment panel.

(2) Where a matter is referred to the Department in accordance with sub-paragraph (1), it shall be reviewed in accordance with the procedure specified in the following sub-paragraphs.

(3) Where more than one contractor specified in the determination in accordance with paragraph 35(7) wishes to refer the matter for dispute resolution, those contractors may, if they all agree, refer the matter jointly, and in that case the Department shall review the matter in relation to those contractors together.

(4) Within the period of 7 days beginning with and including the date of the determination by the assessment panel in accordance with paragraph 35(7), the contractor shall send to the Department a written request for dispute resolution which shall include or be accompanied by –

(a) the names and addresses of the parties to the dispute;

(b) a copy of the contract (or contracts); and

(c) a brief statement describing the nature and circumstances of the dispute.

(5) Within the period of 7 days beginning with and including the date on which the matter was referred to it, the Department shall –

(a) give to the parties notice in writing that it is dealing with the matter; and

(b) include with the notice a written request to the parties to make in writing within a specified period any representations which they may wish to make about the dispute.

(6) The Department shall give, with the notice given under sub-paragraph (5), to the party, other than the one which referred the matter to dispute resolution, a copy of any document by which the dispute was referred to dispute resolution.

(7) The Department shall, upon receiving any representations from a party, give a copy of them to the other party, and shall in each case request (in writing) a party to which a copy of the representations is given to make within a specified period any written observations which it wishes to make on those representations.

(8) For the purpose of assisting it in its consideration of the matter, the Department may –

(a) invite representatives of the parties to appear before it to make oral representations either together or, with the agreement of the parties, separately, and may in advance provide the parties with a list of matters or questions to which it wishes them to give special consideration; or

(b) consult other persons whose expertise it considers will assist it in its consideration of the dispute.

(9) Where the Department consults another person under sub-paragraph (8)(b), it shall notify the parties accordingly in writing and, where it considers that the interests of any party might be substantially affected by the result of the consultation, it shall give to the parties such opportunity as it considers reasonable in the circumstances to make observations on those results.

(10) In considering the dispute, the Department shall consider –

(a) any written representations made in response to a request under sub-paragraph (5)(b), but only if they are made within the specified period;

(b) any written observations made in response to a request under sub-paragraph (7), but only if they are made within the specified period;

(c) any oral representations made in response to an invitation under sub-paragraph (8)(a);

(d) the results of any consultation under sub-paragraph (8)(b); and

(e) any observations made in accordance with an opportunity given under sub-paragraph (9).

(11) Subject to the other provisions of this paragraph and to any agreement by the parties, the Department shall have wide discretion in determining the procedure of the dispute resolution to ensure the just, expeditious, economical and final determination of the dispute.

(12) In this paragraph, “specified period” means such period as the Department shall specify in the request, being not less than one, nor more than two, weeks beginning with and including the date on which the notice referred to is given, but the Department may, if the period for determination of the dispute has been extended in accordance with sub-paragraph (16), extend any such period (even after it has expired) and, where it does so, a reference in this paragraph to the specified period is to the period as so extended.

(13) Subject to sub-paragraph (16), within the period of 21 days beginning with and including the date on which the matter was referred to it, the Department shall determine whether the Board may assign patients to contractors which have closed their lists of patients; and if it determines that the Board may make such assignments, it shall also determine those contractors to which patients may be assigned.

(14) The Department may not determine that patients may be assigned to a contractor which was not specified in the determination of the assessment panel under paragraph 35(7).

(15) In the case of a matter referred jointly by contractors in accordance with sub-paragraph (3), the Department may determine that patients may be assigned to one, some or all of the contractors which referred the matter.

(16) The period of 21 days referred to in sub-paragraph (13) may be extended (even after it has expired) by a further specified number of days if an agreement to that effect is reached by –

(a) the Department;

(b) the Board; and

(c) the contractor which referred the matter to dispute resolution.

(17) The Department shall record its determination, and the reasons for it, in writing and shall give notice of the determination (including the record of the reasons) to the parties.