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43.—(1) The contractor must not sub-contract any of its rights or duties under the agreement in relation to clinical matters to any person unless it has taken reasonable steps to satisfy itself that—
(a)it is reasonable in all the circumstances to do so;
(b)the person to whom any of those rights or duties is sub-contracted is qualified and competent to provide the service; and
(c)the person holds adequate insurance in accordance with regulation 83.
(2) Where the contractor sub-contracts any of its rights or duties under the agreement in relation to clinical matters, it must—
(a)inform [F1NHS England] of the sub-contract as soon as reasonably practicable; and
(b)provide [F1NHS England] with such information in relation to the sub-contract as [F1NHS England] may reasonably request.
(3) Where the contractor sub-contracts clinical services under sub-paragraph (1), the parties to the agreement are deemed to have agreed a variation to the agreement which has the effect of adding to the list of the contractor's premises any premises which are to be used by the sub-contractor [F2as practice premises] for the purposes of the sub-contract and, in these circumstances, regulation 24(1) does not apply.
(4) [F3Subject to sub-paragraph (4A), a contractor] must ensure that any person with whom it sub-contracts is prohibited from sub-contracting the clinical services which that person has agreed with the contractor to provide.
[F4(4A) A sub-contract entered into by a contractor may allow the sub-contractor to sub-contract clinical services the contractor has agreed to provide under the Network Contract Directed Enhanced Service Scheme, pursuant to direction 4 of the Primary Medical Services (Directed Enhanced Services) Directions 2020, provided the contractor has obtained the written approval of [F1NHS England] prior to the sub-contractor sub-contracting those services.]
(5) The contractor, if it has a list of registered patients or a list of registered patients is held in respect of it, must not sub-contract any of its rights or duties under the agreement in relation to the provision of essential services to a company or firm that is—
(a)wholly or partly owned by the contractor, or by any former or current employee of, or partner or shareholder in, the contractor;
(b)formed by or on behalf of the contractor, or from which the contractor derives a pecuniary benefit; or
(c)formed by or on behalf of a former or current employee of, or partner or shareholder in, the contractor, or from which such a person derives or may derive a pecuniary benefit,
where sub-paragraph (6) applies to that company or firm.
(6) This sub-paragraph applies to a company or firm which is or was formed wholly or partly for the purpose of avoiding the restrictions on the sale of goodwill of a medical practice in section 259M1 of the Act (sale of medical practices) and Schedule 21 to the Act (prohibition of sale of medical practices) or in any regulations made wholly or partly under those provisions.
Textual Amendments
F1Words in Regulations substituted (6.11.2023) by The Health and Care Act 2022 (Further Consequential Amendments) (No. 2) Regulations 2023 (S.I. 2023/1071), reg. 1(1), Sch. para. 1
F2Words in Sch. 2 para. 43(3) inserted (1.10.2022) by The National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) (No. 3) Regulations 2022 (S.I. 2022/935), reg. 1(b), Sch. 2 para. 7(4)
F3Words in Sch. 2 para. 43(4) substituted (E.) (1.10.2020) by The National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) (No. 2) Regulations 2020 (S.I. 2020/911), reg. 1(2), Sch. 2 para. 13(a)
F4Sch. 2 para. 43(4A) inserted (E.) (1.10.2020) by The National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) (No. 2) Regulations 2020 (S.I. 2020/911), reg. 1(2), Sch. 2 para. 13(b)
Marginal Citations
M1Section 259 was amended by paragraph 131 of Schedule 4 to the Health and Social Care Act 2012 (c.7).
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