Health and Personal Social Services (Disciplinary Procedures) Regulations (Northern Ireland) 1996

Excessive prescribing by doctors

14.—(1) Where it appears to the Board that a question arises whether the cost of any drug or appliance ordered by a doctor on a prescription form in relation to any patient is, by reason of the character of the drug or appliance in question or the quantity in which it was so ordered, in excess of that which was reasonably necessary for the proper treatment of that patient, it may refer that question for investigation and determination by a committee (in these Regulations known as “the professional committee”) which shall be appointed in accordance with paragraph (3).

(2) No question shall be referred to a professional committee under paragraph (1) after the expiry of a period of 2 years beginning with the date on which the drug or appliance in question was ordered by the doctor.

(3) The professional committee shall be appointed by the Board and shall consist of three doctors—

(a) one of whom shall have substantial experience of clinical pharmacology; and

(b) the other two of whom are engaged in the provision of general medical services, and have been nominated by the Local Medical Committee; and

(c) in a case relating to the provision of maternity medical services one of the doctors so appointed shall be a doctor whose name is included in the obstetric list.

(4) The three doctors appointed under paragraph (3) shall, by agreement, select a chairman of the professional committee from among their number.

(5) The Board shall give notice in writing to the doctor of any question referred by it under paragraph (1) and shall include with the notice an invitation to the doctor to send to the Board within 30 days of the notice being sent to him, his observations on that question.

(6) Where the doctor submits observations under paragraph (5), the Board shall, if it does not withdraw the question under paragraph (7), forward a copy of the observations to the professional committee.

(7) The Board may, by giving notice in writing to the doctor and the professional committee at any time before the hearing begins, withdraw any question referred under paragraph (1), in which case no further action shall be taken under this regulation in relation to that question.

(8) Before determining any question referred under paragraph (1), the professional committee shall hold a hearing and where more than one question has been referred to the professional committee on the same occasion in respect of the same doctor, a single hearing shall be held in relation to all such questions.

(9) The Board shall, after consultation with the professional committee, appoint a day for the hearing and shall, not less than 21 days before that day, give notice in writing to the doctor of the date, time and place of the hearing.

(10) The professional committee may, whether or not on an application by the doctor, or the Board, postpone the date of the hearing, in which case—

(a) it shall inform the Board, and

(b) the Board shall give notice in writing to the doctor of the postponement,

and the provisions of paragraph (9) shall apply as respects the postponed hearing.

(11) The only persons who may be admitted to a hearing before the professional committee are—

(a) the doctor;

(b) not more than two persons who are members or officers of the Board;

(c) any person accompanying the doctor for the purpose of assisting him with the presentation of his case before the professional committee;

(d) any person whose attendance is required for the purpose of giving evidence to the professional committee; and

(e) not more than one person who is a member or officer of the Local Medical Committee and who is authorised by that committee to attend the hearing as an observer only.

(12) Any person mentioned in paragraph (11)(a) or (b), and any person mentioned in paragraph (11)(c) who is not a barrister or a solicitor, may address the professional committee, but a person mentioned in paragraph (11)(a) or (b) shall not put questions directly to any other such person.

(13) Subject to the provisions of paragraphs (11) and (12), the procedure at any hearing shall be such as the professional committee may determine.

(14) The professional committee shall determine whether any question which has been referred to it under paragraph (1) is to be answered in the affirmative or in the negative.

(15) Where the professional committee determines that any question under paragraph (1) is to be answered in the affirmative, it may also determine that a single amount, calculated in accordance with paragraph (16), shall be recovered from the doctor in respect of such questions.

(16) When determining the level of an amount to be specified under paragraph (15), the professional committee—

(a) shall estimate in relation to each question the amount of the excess cost referred to in paragraph (1);

(b) shall have regard to the aggregate of amounts estimated under sub-paragraph (a) of this paragraph; and

(c) subject to paragraph (17), may, if it sees fit, have regard to—

(i) the particular character or quality of any drug or appliance to which any such question relates, and

(ii) the circumstances which gave rise to any affirmative determinations by a professional committee or an appeal body under this regulation in respect of that doctor.

(17) The professional committee shall not, for the purposes of paragraph (16)(c)(ii), have regard to—

(a) any determination of a professional committee—

(i) made less than 30 days before the date of its hearing, or

(ii) in respect of which an appeal under paragraph (19) is pending; or

(b) any determination made more than 6 years before the date of its hearing.

(18) The professional committee shall—

(a) give to the Board and to the doctor notice in writing of its determination (which shall specify any amount which it has determined shall be recovered from the doctor); and

(b) include with the notice—

(i) a statement of the reasons for its determination, and

(ii) where it determines that a question is to be answered in the affirmative, a statement of the doctor’s right of appeal under paragraph (19).

(19) A doctor in respect of whom a professional committee has, under paragraph (14), determined any question in the affirmative may appeal to the Department—

(a) against that determination and against any further determination made in respect of him under paragraph (15); or

(b) only against any determination made in respect of him under paragraph (15),

by giving notice of appeal in accordance with paragraph (20) no later than 30 days after notice of the determination was sent to him under paragraph (18).

(20) A notice of appeal shall be given in writing, shall include a concise statement of the grounds for the appeal, and shall be sent to the Department.

(21) On receipt of a notice of appeal the Department shall—

(a) send to the Board a copy of the notice, inviting it to submit observations in writing on the appeal within 30 days of the copy being sent to it;

(b) where observations are received from the Board within the time allowed under sub-paragraph (a), send to the doctor a copy of those observations, inviting him to submit his comments in writing on those observations within 30 days of the copy being sent to him; and

(c) after the expiry of the period mentioned in sub-paragraph (a) or, where sub-paragraph (b) applies, in that sub-paragraph, refer the notice of appeal, and observations or comments submitted under sub-paragraph (a) or (b), for consideration and determination by an appeal body appointed in accordance with paragraph (22).

(22) An appeal body shall be appointed by the Department and shall, subject to paragraph (23), consist of three doctors of whom—

(a) one shall be nominated by the Department; and

(b) the other two shall be engaged in the provision of general medical services, of whom one shall be nominated by the body mentioned in paragraph (3)(b), and the other shall be nominated by the Department.

(23) No person who was a member of a professional committee which has made a determination under paragraph (14) or (15) in respect of any doctor shall be a member of an appeal body appointed in relation to any appeal against that determination.

(24) The three doctors appointed under paragraph (22) shall, by agreement, select a chairman of the appeal body from among their number.

(25) A doctor may withdraw his appeal by giving notice in writing to the Department at any time before the date of the hearing, in which case—

(a) the Department shall so inform the Board and the appeal body in writing; and

(b) no further action shall be taken under this regulation in relation to the appeal.

(26) Before determining any appeal, the appeal body shall hold a hearing, and where more than one appeal has been brought by the same doctor in respect of the determination by the professional committee of several questions referred to it under paragraph (1) on the same occasion, a single hearing shall be held of all those appeals.

(27) The provisions of paragraphs (9) to (13) shall apply to the hearing before the appeal body as they apply to a hearing before the professional committee, save that—

(a) for any reference in those paragraphs to “the professional committee” there shall be substituted a reference to “the appeal body”;

(b) for any reference in paragraph (9), and in sub-paragraph (a) and (b) of paragraph (10), to “the Board” there shall be substituted a reference to “the Department”; and

(c) the words “who is not a barrister or a solicitor” in paragraph (12) shall not apply.

(28) The appeal body shall—

(a) where the appeal is made under paragraph (19)(a) determine—

(i) whether any question referred to the professional committee under paragraph (1), and to which the appeal relates, is to be answered in the affirmative or the negative, and

(ii) in relation to any such question which it has answered in the affirmative, whether any single amount, and if so what amount, is to be recovered from the doctor in respect of all such questions;

(b) where the appeal is made under paragraph (19)(b), determine, in relation to any question which the professional committee has answered in the affirmative, whether any single amount, and if so what amount, is to be recovered from the doctor in respect of such questions,

and shall determine the appeal accordingly by allowing it or dismissing it.

(29) When determining the level of any amount to be specified under paragraph (28)(a)(ii) or (b), the appeal body—

(a) shall estimate in respect of each question the amount of the excess cost referred to in paragraph (1);

(b) shall have regard to the amount which represents the aggregate of the amounts estimated under sub-paragraph (a); and

(c) subject to paragraph (30), may, if it thinks fit, have regard to—

(i) the particular character or quality of any drug or appliance to which any such question relates, and

(ii) the circumstances which gave rise to any affirmative determinations by a professional committee or an appeal body under this regulation in respect of that doctor.

(30) The appeal body shall not, for the purposes of paragraph (29)(c)(ii) have regard to—

(a) any determination of a professional committee—

(i) made less than 30 days before the date of the appeal body’s hearing, or

(ii) in respect of which an appeal under paragraph (19) is pending; or

(b) any determination made more than 6 years before the date of the appeal body’s hearing.

(31) The appeal body shall give notice in writing to the Board and to the doctor of its determination as to any question mentioned in paragraph (28)(a)(i), and as to the recovery of any amount under paragraph (28)(a)(ii) or (b), and shall include with the notice a statement of its reasons for its determination.

(32) Subject to paragraph (34), where under this regulation a professional committee or an appeal body determines that an amount is to be recovered from a doctor, that amount may be recovered by the Agency either by deduction from that doctor’s remuneration or otherwise.

(33) Any amount determined under this regulation as being recoverable from a doctor shall, to the extent that it is not recovered from his remuneration, be a debt owed by the doctor to the Board.

(34) No amount shall be recovered by the Agency under paragraph (32) by virtue of a determination of a professional committee unless—

(a) the time allowed under paragraph (19) for an appeal against that determination has expired, and no such appeal has been made; or

(b) an appeal has been made and has been withdrawn or dismissed.