Part IGeneral

Citation and commencement1.

These Regulations may be cited as the General Medical Services Regulations (Northern Ireland) 1997 and shall come into operation on 6th October 1997.

Interpretation2.

In these Regulations—

“the Agency” means the Northern Ireland Central Services Agency for the Health and Social Services established under Article 26 of the Order;

“ante-natal period” means the duration of a woman’s pregnancy until the onset of labour;

“assistant” means a doctor who acts as an assistant to a doctor on the medical list;

“Board” means a Health and Social Services Board;

“chemist” has the same meaning as in regulation 2(1) of the Pharmaceutical Regulations;

“child” means a person who has not attained the age of 16 years;

“child health surveillance list” shall be construed in accordance with regulation 26;

“child health surveillance services” means the personal medical services described in regulation 27 and Schedule 4;

“the Disciplinary Procedures Regulations” means the Health and Personal Social Services (Disciplinary Procedures) Regulations (Northern Ireland) 19962;

“doctor” means a medical practitioner;

“domiciliary visit” means a visit to either the place where the patient resides or the place, other than the doctor’s practice premises, where the doctor is obliged, pursuant to paragraph 14 of the terms of service, to render personal medical services to the patient;

“drug” includes medicine;

“full-time doctor” shall be construed in accordance with regulation 13(a);

“group practice” means an association of not less than 2 doctors both or all of whom—

(a)

have their names included in the medical list;

(b)

co-ordinate, in the course of regular contact between them, their respective obligations under the terms of service for doctors to provide personal medical services to their patients; and

(c)

conduct and manage their practices from at least one common set of practice premises;

“half-time doctor” shall be construed in accordance with regulation 13(c);

“job-sharing doctor” shall be construed in accordance with regulation 13(d);

“list” means a doctor’s list of patients;

“local directory” means the local directory of family doctors maintained by a Board pursuant to regulation 16;

“Local Medical Committee” and “Local Pharmaceutical Committee” mean the committees of those names which are recognised by a Board in relation to its area under Article 55(1) of the Order3;

“maternity medical services” shall be construed in accordance with regulation 34 and Schedule 5;

“maximum number” shall be construed in accordance with regulation 23;

“medical card” means a card issued to a person, in a form approved by the Department, for the purpose of enabling him to obtain, or establishing his title to receive, general medical services including maternity medical services, general dental services or general ophthalmic services;

“medical list” shall be construed in accordance with regulation 4(1);

“medical records” means, in relation to any patient, the records maintained in respect of that patient pursuant to paragraph 41 of the terms of service;

“Medical Register” shall be construed in accordance with section 34 of the Medical Act 19834;

“minor surgery list” shall be construed in accordance with regulation 35;

“minor surgery services” means the personal medical services described in regulation 36 and Schedule 7;

“obstetric list” shall be construed in accordance with regulation 30;

“the Order” means the Health and Personal Social Services (Northern Ireland) Order 1972;

“patient” has the same meaning as in paragraph 3 of the terms of service;

“pharmaceutical list” means the list of persons who undertake to provide pharmaceutical services, prepared in pursuance of Article 63(2A) of the Order5;
“Pharmaceutical Regulations” means the Pharmaceutical Services Regulations (Northern Ireland) 19976;

“post-natal period” means the period of 14 days following the conclusion of a pregnancy;

“practice area” means the area in which a doctor is under an obligation to visit patients, by virtue either of his application for inclusion of his name in the medical list or of any variation to it pursuant to these Regulations or the terms of service;

“practice premises” means, in relation to any doctor, the premises at which he is obliged under paragraph 36 of the terms of service to attend in order to be consulted by or to provide treatment or services for, his patients;

“quarter” means a period of 3 months ending on 31st March, 30th June, 30th September or 31st December in any year;

“registered nursing home” shall be construed in accordance with Article 19 of the Registered Homes (Northern Ireland) Order 19927;
“relevant service” has the same meaning as in section 64(1) of the Reserve and Auxiliary Forces (Protection of Civil Interests) Act 19518 as extended to Northern Ireland by the Reserve and Auxiliary Forces (Protection of Civil Interests) (Northern Ireland) Order 19799 and includes services rendered under the Reserve Forces Act 198010 and the Reserve Forces Act 199611;

“restricted doctor” shall be construed in accordance with regulation 13(e);

“restricted list principal” means a doctor who has undertaken to provide general medical services only to a restricted category of patients identified by reference to their connection with a particular establishment or organisation, and “restricted list” shall be construed accordingly;

“restricted services principal” means a doctor who has undertaken to provide general medical services limited to—

(a)

child health surveillance services;

(b)

contraceptive services;

(c)

maternity medical services; or

(d)

minor surgery services,

or to any combination of the above, and “restricted services” shall be construed accordingly;

“suspended by direction of the Tribunal” means suspended as respects the provision of general medical services to patients by a direction of the Tribunal made pursuant to paragraph 8A(2) or 8B(1) of Part I of Schedule 11 to the Order12 or to any provisions in force in England and Wales or Scotland corresponding to those provisions;

“temporary resident” shall be construed in accordance with regulation 25;

“terms of service” means the terms of service contained, or referred to, in Schedule 2;

“three-quarter-time doctor” shall be construed in accordance with regulation 13(b);

“trainee general practitioner” means a doctor who is being trained in general practice;

“training school” means a school approved by the Secretary of State for Northern Ireland under section 137 of the Children and Young Persons Act (Northern Ireland) 196813;

“treatment” means medical attendance and treatment, but does not include child health surveillance services, contraceptive services, maternity medical services or minor surgery services unless the doctor has undertaken to provide such services to the person concerned in accordance with these Regulations;

“young offenders centre” means a place provided, maintained, administered, regulated and managed by the Secretary of State for Northern Ireland under section 2 of the Treatment of Offenders Act (Northern Ireland) 196814 in which offenders, who have been ordered to be detained therein under any enactment, may be kept for suitable training and instruction and in which persons not less than 14 but under 21 years of age who are either remanded in custody or committed in custody for trial may be detained in accordance with any enactment.

Scope and terms of service3.

(1)

The arrangements with doctors for the provision of general medical services which it is the duty of a Board under Articles 17(1)(b) and 56 of the Order15 to make, shall include arrangements for the provision of—

(a)

all necessary and appropriate personal medical services of the type usually provided by general practitioners;

(b)

child health surveillance services;

(c)

contraceptive services, that is to say—

(i)

the giving of advice to women on contraception;

(ii)

the medical examination of women seeking such advice;

(iii)

the contraceptive treatment of such women; and

(iv)

the supply to such women of contraceptive substances and appliances;

(d)

maternity medical services; and

(e)

minor surgery services.

(2)

The arrangements referred to in paragraph (1) shall incorporate the terms of service set out in Schedule 2, and Schedules 8, 9, 10, 11, 12 and 13, shall have effect for the purposes of paragraphs 36, 38, 42, 49(1), 49(2), 51 and 56, respectively of the terms of service.

Part IIThe Medical List

Medical list4.

(1)

Each Board shall prepare a list, to be called “the medical list” of—

(a)

doctors entitled, pursuant to Article 56(2)16 of the Order, to have their names included in the list for the provision of general medical services other than maternity medical services; and

(b)

doctors for the time being appointed under regulation 24,

in its area.

(2)

The Board shall indicate on the medical list whether a doctor is—

(a)

a full-time doctor;

(b)

a three-quarter-time doctor;

(c)

a half-time doctor;

(d)

a job-sharing doctor; or

(e)

a restricted doctor,

having taken account of any condition imposed in relation to him under regulation 13, or varied under regulation 14.

(3)

In respect of any doctor whose name is included in it, the medical list shall indicate—

(a)

if he is on any of the child health surveillance list, the obstetric list or the minor surgery list;

(b)

except in the case of a doctor who has requested otherwise, if he has undertaken to provide contraceptive services and, if so—

(i)

whether he has so undertaken in respect only of patients for whom he or his partners have also undertaken to provide other general medical services; or

(ii)

whether he has so undertaken without such restriction;

(c)

if he is included in the medical list only by virtue of his appointment under regulation 24;

(d)

if he is a restricted list principal or a restricted services principal and, if so, the nature of the restricted list or, as the case may be, of the restricted services; and

(e)

if he has made an arrangement under paragraph 20(2) of the terms of service transferring his obligations at certain times to another doctor, and, if so, the name of the doctor to whom, and the times during which, he has so transferred his obligations.

(4)

In addition to the name of the doctor and any information required to be included by virtue of paragraphs (2) and (3), the medical list shall contain—

(a)

the address of the practice premises where he agrees to attend for the purpose of treating persons, and any telephone number at which he is prepared to receive messages;

(b)

particulars of the days and hours when he agrees to be in attendance at such premises;

(c)

particulars of any days and hours when an appointments system is in operation;

(d)

where he practises in partnership, the name of each partner;

(e)

where he practises in a group practice, the name of each other doctor in that group practice;

(f)

an indication of the geographical boundary of his practice area and details of any conditions as to his practice area attached to the granting of his application by the Board or, on appeal, by the Department;

(g)

provided that the doctor consents to its inclusion, his date of birth or, if he does not so consent, the date of his first full registration as a medical practitioner (whether pursuant to the Medical Act 1983 or otherwise).

Amendment of or withdrawal from the medical list5.

(1)

A doctor shall, unless it is impracticable for him to do so, give notice to the Board within 28 days of any occurrence requiring a change in the information recorded in the medical list.

(2)

A doctor shall, unless it is impracticable for him to do so, give notice in writing to the Board at least 3 months in advance of any day on which he intends either—

(a)

to withdraw his name from any of—

(i)

the medical list;

(ii)

the child health surveillance list;

(iii)

the obstetric list; or

(iv)

the minor surgery list; or

(b)

to cease to provide any of the following services—

(i)

child health surveillance services;

(ii)

contraceptive services;

(iii)

maternity medical services; or

(iv)

minor surgery services.

(3)

On receiving a notice pursuant to paragraph (1) or (2), the Board, subject to paragraph (6), shall—

(a)

in the case of a notice pursuant to paragraph (1), amend the medical list in relation to that doctor; and

(b)

in the case of a notice pursuant to paragraph (2), so amend the medical list, the child health surveillance list, the obstetric list or the minor surgery list, as the case may be, with effect from the date from which the Board has agreed that the withdrawal or cessation shall take effect.

(4)

Any notice pursuant to paragraph (2) may not be withdrawn except with the consent of the Board.

(5)

Where a Board has varied, under regulation 14(3)(a)(ii), any condition imposed on a doctor under regulation 13 it shall amend the medical list accordingly.

(6)

Where, in relation to any doctor, representations are made to the Tribunal in accordance with Schedule 11 to the Order, that his continued inclusion in the medical list would be prejudicial to the efficient provision of general medical services, the doctor shall not, except with the consent of the Department, and subject to such conditions as the Department may impose, be entitled to have his name removed from the medical list until the proceedings on those representations have been determined.

Removal from the medical list6.

(1)

Where a Board determines that a doctor whose name has been included in the medical list—

(a)

has died;

(b)

is no longer a doctor; or

(c)

is the subject of a direction given by the Professional Conduct Committee under section 36 of the Medical Act 1983 (erasure of name from the register or suspension of registration) or of an order made by that Committee under section 38(1) of that Act (immediate suspension),

it shall remove his name from the medical list with effect from the date of its determination or, where sub-paragraph (c) applies, the date on which the direction or order takes effect, if that date is later than the date of the Board’s determination.

(2)

Where a Board determines, in accordance with paragraphs (3) and (4), that a doctor whose name has been included in the medical list for the preceding 6 months has not, during that period, provided any general medical services personally, it may remove his name from the medical list.

(3)

In calculating the period of 6 months referred to in paragraph (2), a Board shall disregard—

(a)

any period during which the doctor provided no general medical services by reason only that his registration as a medical practitioner was suspended as mentioned in Article 56(4C) of the Order17 (suspension by direction or order of the Health Committee or by interim order of the Preliminary Proceedings Committee);

(b)

any period during which the doctor was performing relevant service; and

(c)

any period during which the doctor was suspended by direction of the Tribunal.

(4)

Before making any determination under paragraph (2), a Board shall—

(a)

give the doctor 28 days' notice of its intention;

(b)

afford the doctor an opportunity of making representations to the Board in writing or, if he so wishes, in person; and

(c)

consult the Local Medical Committee.

(5)

Where under paragraph (2) a Board determines to remove a doctor’s name from the medical list, it shall give notice in writing of its determination to the doctor, together with the reasons for it, and inform him of his right of appeal under paragraph (6).

(6)

A doctor to whom a notice has been given under paragraph (5) may, within 21 days of receipt of the notice, appeal to the Department against the decision of the Board, and the Board shall not remove the doctor from the medical list until—

(a)

if no appeal is made, the expiration of the period of 21 days; or

(b)

if an appeal is made, the appeal is determined.

(7)

An appeal under paragraph (6) shall be made in writing and shall set out the grounds of appeal.

(8)

On any appeal pursuant to paragraph (6), the Department may hold an oral hearing of the appeal and in such a case shall—

(a)

appoint one or more persons to hear the appeal who shall report to it on the appeal; and

(b)

not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the Board.

(9)

Where, pursuant to paragraph (8), the Department holds an oral hearing on an appeal, the appellant and the Board may be represented by counsel, solicitor or any other person.

(10)

Where the Department allows the appeal, it shall direct the Board not to remove the doctor’s name from the medical list.

(11)

A Board shall remove from the medical list the name of any doctor who has attained the age of 70 years, with effect from the date on which he attained that age.

(12)

The Board shall give to any doctor whose name is to be removed from the medical list in accordance with paragraph (11)—

(a)

notice in writing to that effect not less than 12 months nor more than 13 months before the date on which his name is to be removed; and

(b)

a further such notice not less than 3 months nor more than 4 months before that date,

but the failure to give notice to any doctor as required by sub-paragraph (a) or (b) shall not prevent the removal of that doctor’s name from the medical list in accordance with paragraph (11).

The Medical Committee7.

The Medical Committee shall be constituted by the Agency in accordance with Schedule 14 for the purpose of carrying out duties in connection with the filling of medical practice vacancies and such other duties as the Agency thinks fit.

Filling or dispersal of medical practice vacancies8.

(1)

Where a practice has been rendered vacant by—

(a)

the death of a doctor whose name is included in the medical list by virtue of regulation 4; or

(b)

the removal or withdrawal of such a doctor from the medical list,

the Board for the area in which the vacancy occurs shall, after consultation with the Local Medical Committee, refer the matter to the Medical Committee and include the information set out in Part I of Schedule 3.

(2)

The Medical Committee shall, in accordance with general principles drawn up by the Department in consultation with the Boards and such organisation as may be recognised by the Department as representing the medical profession, advise the Board as to whether or not the vacancy should be filled.

(3)

Where a Board decides, after consideration of the advice given under paragraph (2), that a vacancy should be filled, the Agency shall, on behalf of the Board, give public notice of such vacancy for a doctor by advertisement in the press or otherwise.

Application to fill a vacancy9.

(1)

An application by a doctor—

(a)

to succeed to a practice declared vacant; or

(b)

to fill a vacancy which has arisen where a Board has resolved that an additional doctor is required in an area otherwise than in succession to another doctor,

shall be made by sending the application to the Agency by no later than the date specified in the notice given under regulation 8(3) in respect of the vacancy to which the application relates, or within such further period as the Agency may for reasonable cause allow, and shall include the information and undertakings specified in Parts IIA and IIB of Schedule 3 and, in the case of a doctor whose name is not already included in the medical list, the evidence, information and undertakings specified in Part IIC of that Schedule.

(2)

On receipt of an application under paragraph (1), the Agency shall constitute a panel comprising—

(a)

members of the Medical Committee;

(b)

representatives of the Board for the area where the vacancy occurs; and

(c)

representatives of the Local Medical Committee,

to consider the applications, and the panel shall, subject to Article 56(2A) of the Order18 (which contains requirements as to knowledge of English), make a recommendation and the recommendation shall be forwarded by the Agency to the Board which shall arrange for the application to be dealt with in accordance with regulation 12.

(3)

In this regulation, in regulation 21(6) and in paragraph 16(5) of the terms of service, “practice declared vacant” means a practice which has been rendered vacant under regulation 8(1) and for which the Board has decided under regulation 8(3) that a doctor is required to fill the vacancy.

Application to practise in partnership10.

(1)

An application by a doctor to practise in partnership shall be made to the Board for the area concerned and shall include the information and undertakings specified in Parts IIA and III of Schedule 3 and, in the case of a doctor whose name is not already included in the medical list, the evidence, information and undertakings specified in Part IIC of that Schedule.

(2)

On receipt of an application pursuant to paragraph (1), the Board shall, subject to Article 56(2A) of the Order and if it is satisfied that the approval of such application is necessary or expedient to secure the due discharge by it of its duty under Article 56(1) of the Order, forward the application to the Agency for consideration by the Medical Committee, and the Committee’s recommendation as to whether or not such application should be granted shall be forwarded by the Agency to the Board which shall arrange for the application to be dealt with in accordance with regulation 12.

Application to practise as a restricted list or restricted services principal11.

(1)

An application by a doctor for the inclusion of his name in the medical list only as a restricted list principal or a restricted services principal, other than one to which regulation 9(1) or 10(1) applies, shall be made to the Board for the area concerned and shall include the evidence, information and undertakings specified in Parts IIA and IIC of Schedule 3.

(2)

On receipt of an application pursuant to paragraph (1), the Board shall, subject to Article 56(2A) of the Order and if it is satisfied that the approval of such application is necessary or expedient to secure the due discharge by it of its duty under Article 56(1) of the Order, forward the application to the Agency for consideration by the Medical Committee, and the Committee’s recommendation as to whether or not such application should be granted shall be forwarded by the Agency to the Board which shall arrange for the application to be dealt with in accordance with regulation 12.

Board’s decision on applications and inclusion in the medical list12.

(1)

The Board shall consider a recommendation made under regulation 9(2), 10(2) or 11(2) and, subject to the appropriate condition specified under regulation 13, shall notify the Agency of its decision.

(2)

Where, under paragraph (1), the Board grants the application of a doctor whose name is not already included in the medical list, it shall add his name to the medical list.

Conditions under which general medical services are to be provided13.

Where a Board grants an application under regulation 12, it shall specify, as a condition, that the doctor shall provide such services as—

(a)

a full-time doctor, that is to say a doctor who is to provide general medical services during not less than 26 hours in any week in which he is, pursuant to paragraph 36 of the terms of service, normally available to provide such services;

(b)

a three-quarter-time doctor, that is to say a doctor who is to provide such services during less than 26 hours, but not less than 19 hours, in any such week;

(c)

a half-time doctor, that is to say a doctor who is to provide such services during less than 19 hours, but not less than 13 hours, in any such week;

(d)

a job-sharing doctor, that is to say a doctor—

(i)

who is to practise in partnership with another doctor whose name is included in the medical list; and

(ii)

who is himself to provide such services during less than 26 hours in any such week; and

(iii)

for whom the hours during which he is to provide such services are, when aggregated with the hours of that other doctor, to amount to not less than 26 hours in any such week; or

(e)

a restricted doctor, that is to say a doctor—

(i)

who is a restricted list principal or a restricted services principal; and

(ii)

who is to provide general medical services during such number of hours in any week as he shall have specified in his application pursuant to regulation 11.

Variation of conditions14.

(1)

A doctor whose name is included in the medical list may apply, in accordance with paragraph (2), for the variation of any condition—

(a)

imposed in relation to him by the Board under regulation 13; or

(b)

specified in relation to him by the Department on the determination of any appeal from a decision by the Board.

(2)

An application for the purposes of paragraph (1) shall be made in writing to the Board and shall include the information specified in Part IV of Schedule 3.

(3)

On consideration of an application under this regulation the Board—

(a)

in determining the application—

(i)

may refuse to vary the condition in question; or

(ii)

may vary the condition by imposing in relation to the doctor such other condition mentioned in regulation 13 as has been requested in the application;

(b)

shall give notice of its decision in writing to the doctor; and

(c)

where it has varied a condition under head (ii) of sub-paragraph (a), shall amend the medical list accordingly.

(4)

Where the Board refuses under paragraph (3)(a)(i) to vary a condition it shall, when it gives notice to the doctor of its decision—

(a)

include with the notice a statement of the reasons for its decision; and

(b)

advise the doctor in writing of his right of appeal under paragraph (5).

(5)

A doctor may appeal to the Department against the refusal of the Board to vary a condition under this regulation and—

(a)

paragraphs (2) to (9) of regulation 15 shall apply to the making and determination of any such appeal; and

(b)

where the Department allows such an appeal, it shall remit the application to that Board for reconsideration, and regulation 15(11) shall apply in that event.

Appeal to the Department15.

(1)

A doctor may appeal to the Department against the refusal of an application to which regulation 9, 10, or 11 applies and any appeal shall be made and determined in accordance with this regulation.

(2)

A doctor may appeal by sending to the Department notice of appeal within a period of 21 days beginning with and including the date on which the notice of the refusal of the Board is given to him.

(3)

The notice of appeal shall contain a concise statement of the grounds of appeal.

(4)

If it appears to the Department that the appeal is of such a nature that it can properly be determined without an oral hearing, it may dispense with an oral hearing and determine the appeal summarily, and shall communicate the decision, together with the reason for it, in writing to the appellant, the Board and the Agency.

(5)

If the Department is of the opinion that an oral hearing is required, it shall appoint 3 or more persons to hear the appeal.

(6)

An oral hearing shall take place at such time and place as the Department may direct, and, not less than 14 days before the date fixed for the hearing, notice of the hearing shall be sent to the appellant, the Board, the Agency and, in the case of an application to which regulation 9 applies, any doctors whose application for appointment to the vacancy to which the application relates was granted.

(7)

Subject to paragraphs (8) and (9), the procedure at the oral hearing shall be such as the person or persons hearing the appeal may determine.

(8)

The appellant and any of the parties to whom notice of the hearing is required to be given, may attend and be heard in person or by counsel or solicitor or other representative.

(9)

The Board and the Agency may be represented at the hearing by any duly authorised officer or member or by counsel or solicitor.

(10)

The persons hearing the appeal shall make a report to the Department, stating the relevant facts and their conclusions, and the Department, after taking the report into consideration, shall give its decision and communicate it, together with the reasons for it, in writing to—

(a)

the appellant;

(b)

the Board;

(c)

the Agency; and

(d)

any doctor to whom notice of the hearing has been sent in accordance with paragraph (6).

(11)

Where, on allowing an appeal, the Department remits an application to the Board for reconsideration—

(a)

it shall give to the Board such directions as it sees fit; and

(b)

the Board shall redetermine the application and in doing so shall comply with any directions given by the Department under sub-paragraph (a) with respect to the determination of that application.

Local directory of family doctors16.

(1)

Subject to the requirements of this regulation and regulation 17, a Board shall prepare, and thereafter maintain, a list to be known as the local directory of family doctors comprising, in respect of each doctor in its area whose name is included in the medical list, the following information—

(a)

all the information in respect of the doctor in the medical list other than his date of birth, unless the doctor has agreed to its inclusion in the local directory;

(b)

where the doctor’s date of birth is included in the medical list but he has not agreed to its inclusion in the local directory, the date of his first full registration as a medical practitioner whether pursuant to the Medical Act 198319 or otherwise;

(c)

the sex of the doctor;

(d)

details of any medical qualifications held by the doctor which he is entitled to have registered pursuant to section 16 of the Medical Act 1983 (registration of qualifications), including the date on which the qualification was awarded;

(e)

the nature of any clinic provided by the doctor for his patients and the frequency with which it is held;

(f)

the number of assistants and trainee general practitioners employed by him;

(g)

details of—

(i)

the number of other persons employed or available at his practice premises to assist him in the discharge of his obligations under the terms of service;

(ii)

the nature of the services provided by each such person; and

(iii)

the average number of hours normally worked by each such person during any week;

(h)

any arrangements for the provision of any deputy notified to the Board under paragraph 26(3) of the terms of service; and

(i)

where, and to the extent that, the doctor so requests—

(i)

details of any languages, other than English, spoken by the doctor or by any person referred to in sub-paragraph (f) or (g); and

(ii)

details of any particular clinical interests of the doctor.

(2)

Paragraph (1) shall apply in the case of a restricted list principal or a restricted services principal only to the extent that the Board sees fit.

(3)

The Board may, to the extent that it sees fit, also include in the local directory other details or material relating to general medical services, general dental services, general ophthalmic services and pharmaceutical services in its area.

(4)

The local directory shall include the name of each doctor in alphabetical order.

(5)

Where a doctor practises in partnership or in a group practice with other doctors, the information regarding his practice which falls to be included in the local directory pursuant to paragraph (1)(e), (f), (g), (h) and (i) may, provided each doctor in the partnership or, as the case may be, the group practice agrees, be included in the entry relating to only one of those doctors.

(6)

Notwithstanding the provisions of regulation 41, the Board may compile extracts from the information in the local directory by reference to geographical parts of the Board’s area and may make any such extract available to persons to whom, in the opinion of the Board, it is likely to be of interest.

Amendment of local directory17.

(1)

A doctor shall, unless it is impracticable for him to do so, notify the Board within 28 days of any occurrence requiring a change in the information recorded about him in the local directory.

(2)

The Board shall, in the event of a notification pursuant to paragraph (1), make any necessary amendment to the local directory.

Part IIIGeneral medical services other than child health surveillance services, contraceptive services, maternity medical services and minor surgery services

Doctors' lists18.

(1)

In respect of each doctor whose name is included in the medical list, the Agency shall prepare and keep up to date a list of the patients accepted by or assigned to the doctor under this Part, otherwise than as temporary residents.

(2)

The Agency shall, from time to time, give each doctor whose name is included in the medical list the information described in Part V of Schedule 3 with regard to persons included in or removed from his list.

(3)

Subject to regulation 21(7), a person accepted by a doctor for inclusion in his list shall be included in that list from the date on which notification of such acceptance is received by the Agency.

(4)

Where a person for whose treatment a doctor is responsible dies, or is absent from the United Kingdom for a period of more than 3 months, he shall be removed from the doctor’s list from the date on which the Agency first receives notification of the death or that the absence has exceeded 3 months.

(5)

Where a person for whose treatment a doctor is responsible—

(a)

leaves the United Kingdom with the intention of being away for a period of at least 3 months;

(b)

is enlisted in Her Majesty’s forces;

(c)

is serving a sentence of imprisonment of more than 2 years or sentences totalling in the aggregate more than that period at a prison or young offenders centre,

he shall be removed from the doctor’s list from the date on which the Agency first receives notification of the departure, enlistment or imprisonment.

(6)

Any removal of a person from a doctor’s list caused by the transfer of a person to the list of another doctor, otherwise than in pursuance of a notice under regulation 21(7) or (10), shall take effect—

(a)

from the date on which the Agency receives notification of the acceptance of the person by the last-named doctor for inclusion in his list; or

(b)

subject to the consent of the Agency, from such date, being not earlier than the date of that consent, as may be agreed between the doctors.

(7)

Where a doctor has requested the Agency to remove a person from his list in accordance with paragraph 9 of Schedule 2, the removal shall take effect from the date mentioned in that paragraph.

(8)

Where a doctor has requested the Agency to remove a person from his list with immediate effect in accordance with paragraph 10 of the terms of service—

(a)

such removal shall take effect at the time mentioned in sub-paragraph (3) of that paragraph; and

(b)

on receipt of the notification mentioned in sub-paragraph (1) of that paragraph, the Agency shall—

(i)

in writing, acknowledge it and also give notice of the removal to the person concerned; and

(ii)

take all reasonable steps to assign the person to another doctor before the end of the next working day, or as soon as possible thereafter, and regulation 20 shall apply to such an assignment as if the person had applied for an assignment in accordance with that regulation but as if the word “still” were omitted from paragraph (4) of that regulation.

(9)

Any other removal of a person from a doctor’s list shall take effect from the date on which the notice is sent by the Agency to the doctor or from such other date, not being earlier than that date, as may be agreed between the Agency and the doctor.

Application for services19.

(1)

An application by a person (being a person ordinarily resident in Northern Ireland or to whom the provisions of the Health Services (Persons not Ordinarily Resident in Northern Ireland) Regulations (Northern Ireland) 197020 apply) to a doctor for inclusion in his list for the provision of general medical services, shall be made by delivering to the doctor a medical card or a form of application, approved by the Agency, signed (in either case) by the applicant or a person authorised on his behalf in accordance with paragraph (2).

(2)

An application to a doctor for inclusion in his list may be made (otherwise than by the doctor concerned)—

(a)

on behalf of any child, by either parent or, in the absence of both parents, the guardian or other adult person who has the care of the child;

(b)

on behalf of any person who is incapable of making such an application, by a relative or other adult person who has the care of such person; or

(c)

on behalf of any person under 18 years of age who is—

(i)

in the care of an authority in whose care he has been placed under the provisions of the Children (Northern Ireland) Order 199521, by a person duly authorised by that authority;

(ii)

in the care of a voluntary organisation, by that voluntary organisation or a person duly authorised by it; or

(iii)

in a training school, by the manager of that training school.

Assignment of persons to doctors20.

(1)

Where—

(a)

a person who is not on the list of any doctor has been refused acceptance by a doctor for inclusion in his list; or

(b)

a person has been refused such acceptance by a doctor as a temporary resident,

he may apply to the Agency for assignment to a doctor, and the provisions of this regulation shall apply in relation to that application.

(2)

An application under paragraph (1) shall be made in writing and shall be considered by the Agency, which shall assign the applicant to such doctor whose name is included in the medical list as it thinks fit, having regard to—

(a)

the respective distances between the person’s residence and the practice premises of the doctors in the area;

(b)

whether within the previous six months the person has been removed from the list of any doctor in that area at the request of that doctor; and

(c)

such other circumstances, including those concerning the doctors in that area and their practices, as the Agency shall think relevant,

and shall notify the doctor accordingly.

(3)

Nothing in paragraph (2) shall—

(a)

require a doctor to provide child health surveillance services, contraceptive services, maternity medical services or minor surgery services for a patient who is assigned to him unless, pursuant to regulation 27, 28, 34 or 36, as the case may be, he has accepted that patient for the provision of such services; or

(b)

enable the Agency to assign any person to a doctor whose list equals or exceeds the maximum number, without the consent of the Department.

(4)

Where the Department refuses its consent for the purpose of paragraph (3)(b), and the Agency is satisfied, after due enquiry, that the person concerned still wishes to be assigned to a doctor, it shall, as soon as practicable, assign that person to another doctor or, as the case may be, seek the Department’s consent, where required under paragraph (3)(b), for assignment to another doctor.

(5)

The Agency may exempt from the liability to have persons assigned to him under this regulation, any doctor who applies to the Agency for that purpose and, in considering such an application, shall have regard to the doctor’s age, state of health and the number of persons on his list and, where the application relates only to a specified person who has previously been removed from the list of the doctor, the circumstances of that removal; and the Agency shall notify any such doctor in writing of any decision under this paragraph.

Change of doctor21.

(1)

A person who is on a doctor’s list of patients may apply to any other doctor providing general medical services for acceptance on that other doctor’s list of patients.

(2)

An application for the purposes of paragraph (1) shall be made in accordance with regulation 19.

(3)

A person who has made an application under paragraph (1) and has been refused acceptance by any doctor, may apply to the Agency for assignment to a doctor whose name is included in the medical list.

(4)

The Agency shall inform a doctor as soon as practicable of the removal of a patient from his list on transfer to the list of another doctor.

(5)

Subject to paragraphs (6) and (7), the Agency shall, on the death of a doctor, or on the removal or withdrawal from the medical list of the name of any doctor, notify the persons on the list of that doctor of such death, removal or withdrawal.

(6)

Where a successor is appointed to a practice declared vacant, the Agency shall, by notice in writing, inform the persons on the list of the doctor who last carried on that practice of the name of the successor (and, if more than one, of each of them) and of the names of any partners and of the address of their practice premises.

(7)

The notice mentioned in paragraph (6) shall state that the person to whom it is given will be deemed, from the date specified in the notice, to be on the list of a named successor, unless that person within 14 days of that date gives notice in writing to the Agency that he does not wish to be included in that list.

(8)

Where no successor is to be appointed to a practice, the Agency shall notify each person on the list of the doctor who last carried on that practice, that his name has been removed from that list and either—

(a)

that his name has been transferred to the list of another doctor named in the notice who may, or may not, have been a partner of the doctor whose name has been removed from the medical list; or alternatively

(b)

that he has the right to apply to another doctor for acceptance for inclusion in his list,

and where sub-paragraph (a) applies, the Agency shall request the person to inform it whether he is agreeable to the transfer.

(9)

A doctor who has returned to his practice at the end of a period of relevant service (in this regulation called “the first doctor”) shall, within one month of his return, inform the Board in writing that he has resumed practice and the Board shall notify the Agency of such resumption.

(10)

Where the Agency has been notified in accordance with paragraph (9) it shall, within 28 days, send a notice to every person who—

(a)

was on the first doctor’s list at the beginning of a period of relevant service; and

(b)

is still residing at the address at which he was then residing and who has been transferred, by reason only of the doctor’s departure on relevant service, to the list of another doctor,

stating that the first doctor has resumed practice and that the person will be restored to his list unless, not later than 14 days after the date of the notice, that person gives notice in writing to the Agency that he wishes to remain on the list of the other doctor.

(11)

After the expiry of the period of 14 days mentioned in paragraph (10), the Agency shall inform each of the other doctors concerned of the persons who are transferred from his list to the list of the first doctor and shall also inform each of those other doctors of the persons who have elected to remain on his list.

(12)

Nothing in this regulation shall require the Agency to give any notice concerning the making or termination of arrangements under regulation 24.

Removal from doctor’s list22.

(1)

Where a person no longer wishes to avail himself of general medical services—

(a)

he may, at any time, give notice to the Agency that he wishes to be removed from a doctor’s list; and

(b)

the Agency shall notify him and the doctor concerned that, on a specified date, being 14 days after the date of the receipt of the notice by the Agency, his name will be removed from the doctor’s list.

(2)

Subject to paragraph (4), where the Agency is satisfied that a person on the list of a doctor providing general medical services no longer resides at a place where that doctor is under an obligation under these Regulations to visit and treat him, the Agency shall—

(a)

inform that person and the doctor that the doctor is no longer obliged to visit and treat the person;

(b)

advise the person in writing either to obtain the doctor’s agreement under paragraph 14(5)(b) of the terms of service to visit him if his condition so requires, or to seek acceptance for inclusion in the list of another doctor; and

(c)

inform the person that if, after the expiration of 30 days from the date of the written advice mentioned in sub-paragraph (b), he has not acted in accordance with that advice, the Agency will remove him from the doctor’s list.

(3)

If, at the expiration of the period of 30 days referred to in paragraph (2)(c), the Agency has not been notified of the action taken, it shall remove the patient from the doctor’s list and inform him and the doctor accordingly.

(4)

Where a person on the list of a doctor providing general medical services has moved to an address outside the area in which the doctor has undertaken to provide such services or the address of that person is no longer known to the Agency, the Agency shall—

(a)

give to that doctor notice in writing that it intends, at the end of the period of 6 months commencing with the date of the notice, to remove the person from the doctor’s list; and

(b)

at the end of that period, remove the person from the doctor’s list, unless within that period the doctor satisfies the Agency that he is still responsible for providing general medical services for that person, including visiting and treating him when necessary.

(5)

Where the Agency receives particulars of persons who are pupils at, or staff or residents of, a school or residential institution where a doctor provides general medical services, it shall remove from that doctor’s list any persons appearing on his list as pupils at, or staff or residents of, that school or institution who are not shown in those particulars.

(6)

Where the Agency has made a request to a school or residential institution to provide the particulars mentioned in paragraph (5) and has not received them, it may, after consulting the doctor, remove from the doctor’s list any persons appearing on the list as pupils at, or staff or residents of, the school or institution.

Limitation on number of persons on doctors' lists23.

(1)

This regulation applies as to the aggregate maximum number (“the maximum number”) of persons a doctor may have on his list in all areas in which he provides general medical services in addition to any persons whom he has accepted for inclusion in his list for the provision of contraceptive services only.

(2)

Except as otherwise provided in this regulation, and in regulation 24(16), the maximum number shall be—

(a)

3,500 for a doctor carrying on practice otherwise than as an assistant or in a partnership;

(b)

4,500 for a doctor carrying on practice in partnership, subject to a maximum average of 3,500 for each of the partners in the practice,

and, where the doctor employs an assistant, such further number not exceeding 2,000 for each assistant as the Agency or, on appeal, the Department, may decide having regard to the circumstances of the practice and the amount of time given to it by any assistant.

(3)

For the purposes of determining the maximum number of persons on a doctor’s list, the number of persons allocated to an assistant shall be regarded as being on the list of the doctor by whom he is employed.

(4)

For the purposes of paragraph (2), a doctor who is in partnership shall be deemed to be an assistant, and not a partner, unless the Board or, on appeal, the Department is satisfied that—

(a)

he discharges the duties and exercises the powers of a partner in connection with the practice of the partnership; and

(b)

either—

(i)

in the case of a full-time doctor, he is entitled to a share of the profits which is not less than one third of the share of the partner with the greatest share; or

(ii)

in the case of a three-quarter-time doctor, he is entitled to a share of the profits which is not less than one quarter of the share of the partner with the greatest share; or

(iii)

in the case of a half-time doctor, he is entitled to a share of the profits which is not less than one fifth of the share of the partner with the greatest share; or

(iv)

in the case of a job-sharing doctor who practises in partnership with another job-sharing doctor and at least one other doctor, he is entitled to a share of the profits which, when added to the share of the other job-sharing doctor with whose hours his hours are being aggregated for the purposes of regulation 13, is not less than one third of the share of the member of the partnership with the greatest share.

(5)

The Agency shall notify each doctor of the number of patients on his list as at the first day of each quarter and of the number of any excess over the maximum number.

(6)

A doctor shall, within 2 months from the date on which the excess was notified to him in accordance with paragraph (5), take steps to reduce the number of persons on his list to the maximum number by—

(a)

taking a partner;

(b)

engaging an assistant; or

(c)

notifying the Agency of the names of the necessary number of patients on his list whom he wishes to have removed from his list under paragraph 9 or 11 of the terms of service,

and if, at the end of that time, the measures mentioned in this paragraph have not resulted in the reduction of the number of persons to the maximum number, the Agency shall remove from his list the necessary number of patients, the selection of such patients being at the discretion of the Agency.

(7)

Where—

(a)

a doctor gives notice under paragraph (6)(c); or

(b)

a doctor whose name is included in the medical list in respect of more than one address and who ceases to practise at any one of them, informs the Agency of his wish to have removed from his list the patients who would have attended for treatment at the address at which he has ceased to practise,

the Agency shall, subject to paragraph (8), send a notice to each person to whom sub-paragraph (6)(c) applies or sub-paragraph (b) relates to inform him that he should apply to another doctor for acceptance for inclusion in his list.

(8)

The Agency, after consulting the relevant Local Medical Committee, may permit the doctor who wishes to have the patient removed from his list under paragraph (6)(c) or (7)(b), to name another doctor who—

(a)

is willing to accept the person for inclusion in his list; and

(b)

has given his written consent in circumstances where such acceptance will not result in the number of patients on that other doctor’s list exceeding the maximum number,

the Agency shall notify that person accordingly and the name of any such person shall be included in the list of the doctor named in the notice until such time as the person has chosen another doctor or has informed the Agency in writing that he wishes not to be so included.

(9)

Where the number of patients on a doctor’s list exceeds the maximum number and is due to—

(a)

the creation of a partnership of which the doctor is a member; or

(b)

the death or retirement of a partner or the cessation of employment of an assistant in circumstances where the doctor is actively seeking a new partner or assistant,

the Agency may, on the doctor’s undertaking not to accept for inclusion in his list further patients other than the children of existing patients, permit him to retain, for such period not exceeding 9 months as it may determine from the date of the event which resulted in the number of patients exceeding the maximum number, all the patients on his list (and, in a case falling within sub-paragraph (b), on the list, if any, of his former partner) at that date.

(10)

The Agency may, with the consent of the Department, extend any period mentioned in paragraph (9).

(11)

The Agency may, in special circumstances, subject to consent of the Department and any conditions it may impose, permit a doctor to have on his list such number of persons in excess of the maximum number as it thinks fit.

(12)

In carrying out its function under this regulation, the Agency shall consult as necessary with the relevant Board.

(13)

Nothing in this regulation shall—

(a)

restrict a doctor from accepting for inclusion in his list persons who apply to him as temporary residents; or

(b)

exempt him from any liability under the terms of service to give treatment immediately required to any person who applies for acceptance for inclusion in his list or to give emergency treatment.

(14)

An appeal under paragraph (2) or (4) shall be made by sending to the Department within 30 days of the date on which notice of the decision of the Agency was given, a notice of appeal containing a concise statement of the grounds of appeal.

(15)

The Department shall, on receipt of any notice of appeal under this regulation, send a copy of that notice to the Agency.

(16)

The Agency may, within 30 days from the date on which the Department sent a copy of the notice of appeal, submit representations in writing to the Department on the appeal.

(17)

On any appeal pursuant to paragraph (2) or (4), the Department may hold an oral hearing and, in such a case, shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the Agency.

(18)

The Department shall, upon determination by it of an appeal under this regulation, give notice of its decision in writing, together with the reasons for it, to the appellant and to the Agency.

Temporary provision of services24.

(1)

This regulation applies to the making of arrangements for the temporary provision of general medical services.

(2)

Where a doctor’s name ceases to be included in the medical list or his registration is suspended under sections 37(1) or (2), 38(1) and 42(3)(b) of the Medical Act 198322, the Board may, after consultation with the Local Medical Committee—

(a)

make arrangements for the temporary provision of general medical services for that doctor’s patients, which may consist of or include the appointment of one or more doctors to undertake the treatment of such persons; and

(b)

where—

(i)

the doctor whose name was included in the medical list by virtue of regulation 4(1)(a) dies; and

(ii)

within 7 days of the date of death, any person applies to the Board in writing on behalf of the estate of that doctor for the appointment of one or more named doctors,

appoint one or more of the named doctors to undertake the treatment of the deceased doctor’s patients,

and where a doctor is suspended by direction of the Tribunal the Board shall, after consultation with the Local Medical Committee, make arrangements for the temporary provision of general medical services for the suspended doctor’s patients with one or more doctors whose names are included in the medical list (one or more of whom may be partners of the suspended doctor) or with one or more doctors appointed for the purpose, or both.

(3)

The Board may make such arrangements as it thinks fit (including arrangements in relation to accommodation) to enable any doctor appointed in accordance with paragraph (2) to undertake the treatment of the deceased doctor’s patients and, in the case of any doctor appointed under paragraph (2)(b), shall, where practicable, first consult the person who applied to it for the appointment of that doctor.

(4)

Subject to paragraphs (10), (16) and (17), arrangements under paragraph (2) shall subsist for such period as the Board may determine but not beyond the date on which the vacancy is filled or the suspension referred to in that paragraph ceases to have effect.

(5)

Where it appears to a Board, after consultation with the Local Medical Committee, that a doctor is incapable of carrying out his obligations under the terms of service because of his physical or mental condition, it may require him to be medically examined.

(6)

Where a Board is satisfied—

(a)

after receiving from the Local Medical Committee a report of a medical examination under paragraph (9) that, because of his physical or mental condition; or

(b)

that because of his continued absence,

a doctor’s obligations under the terms of service are not being carried out adequately, it may, after consultation with the Local Medical Committee and with the consent of the Department, make arrangements for the temporary provision of general medical services for that doctor’s patients which may consist of or include the appointment of one or more doctors to undertake the treatment of such persons, and may vary such arrangements as necessary.

(7)

A doctor shall not be appointed under paragraph (2) or (6) unless he is suitably experienced (other than by virtue of being a restricted services principal) within the meaning of Article 8 of the Health and Personal Social Services (Northern Ireland) Order 197823.

(8)

Subject to paragraph (11), arrangements under paragraph (6) shall subsist for such period as the Board may determine but not, in a case to which paragraph (6)(a) applies, beyond the date on which the Board is satisfied, after consulting the Local Medical Committee, that the doctor is fit to resume his practice.

(9)

Where under paragraph (5) or (10) a doctor is required to be medically examined—

(a)

he shall submit himself for medical examination by a doctor appointed by the Local Medical Committee; and

(b)

the Local Medical Committee, having considered the report of that medical examination, shall make a report in writing to the Board as to the doctor’s capability to carry out his obligations under the terms of service.

(10)

Before varying or terminating any arrangements made under paragraph (6), but after consulting the Local Medical Committee, the Board may require the doctor to be medically examined.

(11)

Where the Board proposes that the arrangements under paragraph (2) or (6) shall continue—

(a)

for longer than one year;

(b)

for such shorter period as the Department may specify in any particular case; or

(c)

beyond any period specified in sub-paragraph (a) or (b),

it shall so notify the Department in writing not less than 30 days, or as soon as is practicable, before the expiry of that period or further period and shall, in each case, obtain the consent of the Department to the continuance of the arrangements.

(12)

The Board shall—

(a)

give reasonable notice, in writing, of the termination of arrangements under paragraph (2) or (6) to the doctor with whom they were made; and

(b)

as soon as is practicable, notify the Department in writing that such termination has taken place.

(13)

Where the Board makes any arrangements under this regulation in relation to the treatment of the patients of any doctor it shall, where practicable, notify in writing that doctor of such arrangements and of their variation or termination.

(14)

A doctor appointed under this regulation shall agree in writing to be bound throughout his appointment by the terms of service which were applicable to the doctor, the treatment of whose patients he is appointed (with or without the other doctors) to undertake, except that nothing in this regulation shall require him to provide child health surveillance services, contraceptive services, maternity medical services or minor surgery services which he has not undertaken to provide.

(15)

Where paragraph (16) does not apply, any person on the list of the doctor for the treatment of whose patients arrangements are made under this regulation shall be deemed to remain on that list while those arrangements subsist, unless that person is transferred to the list of another doctor, and any person who applies to the doctor appointed under this regulation for acceptance for inclusion in his list shall, if so accepted, be recorded by the Agency as being—

(a)

where that doctor’s name is included in the medical list by virtue of regulation 4(1)(a), on his list; and

(b)

in any other case, on the list of the doctor for the treatment of whose patients arrangements are made under this regulation.

(16)

In the case of a doctor who has been suspended by direction of the Tribunal—

(a)

the Agency shall temporarily assign each of that doctor’s patients to the list of one of the doctors with whom arrangements for the temporary provision of general medical services are made for the duration of those arrangements; and

(b)

to the extent necessary to accommodate any additional patients temporarily assigned under sub-paragraph (a), the limitation contained in regulation 23 on the number of persons who may be on a doctor’s list shall not apply for the duration of those arrangements.

(17)

Where arrangements such as are referred to in paragraph (16) are in operation when a suspension by direction of the Tribunal ceases to have effect—

(a)

in the case where the suspended doctor’s name continues to be included in the medical list, the Agency shall reassign to him all those patients temporarily assigned under paragraph (16) who are still on the list of the doctor to whom they were so assigned; and

(b)

in the case where his name ceases to be included in the medical list, the arrangements referred to in paragraph (16) shall cease to have effect (without prejudice to any new arrangements which may be made under this regulation).

(18)

The Agency—

(a)

may deduct from the remuneration of a doctor—

(i)

for the treatment of whose patients arrangements are made under paragraph (6); or

(ii)

consequent upon whose suspension by direction of the Tribunal arrangements are made for the temporary provision of general medical services for that doctor’s patients,

the cost, in whole or in part, of any such arrangements; and

(b)

in the case of a doctor performing relevant service, shall deduct from his remuneration the cost of any such arrangements.

(19)

In the application of the Order to the making of arrangements for the temporary provision of general medical services and the provision of such services in pursuance of those arrangements—

(a)

Article 57(1) (which prohibits, with exceptions, payment of a fixed salary) shall have effect as if the words “otherwise than temporarily” were inserted after the words “general medical services”; and

(b)

Article 56(2A)24 (which contains requirements as to knowledge of English) shall apply to a doctor appointed under this regulation and, in respect of any such doctor, Article 56(2A) shall have effect as if for the words from “shall” to “paragraph (2)(a)” there were substituted the words “shall be appointed to provide general medical services temporarily”.

Temporary residents25.

(1)

A person who is ordinarily resident in Northern Ireland or to whom the provisions of the Health Services (Persons Not Ordinarily Resident in Northern Ireland) Regulations (Northern Ireland) 197025 apply, who is residing temporarily in an area and who is not on the list of a doctor providing general medical services in that area, may, if he requires treatment, apply to any doctor to be accepted by him as a temporary resident.

(2)

For the purposes of paragraph (1), a person shall be regarded as temporarily resident in a place if, when he arrives in that place, he intends to stay there for more than 24 hours but not more than 3 months.

(3)

Subject to paragraph (4), a person who is accepted as a temporary resident shall not be removed from the list of any doctor in which he is already included.

(4)

If the Agency is satisfied in relation to a person, after due enquiry—

(a)

that his stay in the area of temporary residence has exceeded 3 months; and

(b)

that he has not returned to the area of former residence,

it shall remove him from the doctor’s list of patients in the area of his former residence and, if practicable, inform him of that fact and of his entitlement to seek acceptance for inclusion in the list of any doctor, including the doctor by whom he has been treated as a temporary resident, in the area in which he is living.

Part IVChild health surveillance services, contraceptive services, maternity medical services and minor surgery services

Child health surveillance list26.

(1)

Each Board shall maintain a list (in these regulations referred to as “a child health surveillance list”) of the names of those doctors in its area who have satisfied it or, on appeal, the Department, in accordance with the following provisions of this regulation, that they have such medical experience and training as are necessary to enable them properly to provide child health surveillance services.

(2)

A doctor may apply, in accordance with paragraph (3), to the Board for the area in which his main practice premises are situated for the inclusion of his name in the child health surveillance list.

(3)

An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part VI of Schedule 3.

(4)

Unless the doctor otherwise agrees, the Board shall determine an application made in accordance with paragraph (3) within 2 months of receiving it.

(5)

The Board may hold an oral hearing of any application and shall not refuse an application without giving the doctor an opportunity of an oral hearing.

(6)

Where the Board decides to hold an oral hearing, it shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the doctor.

(7)

When determining an application under this regulation the Board shall have regard in particular to—

(a)

any postgraduate qualification held by him relevant to the provision of child health surveillance services; and

(b)

the criteria listed in paragraph 1 of Part VII of Schedule 3,

and shall seek and take into account any medical advice it considers necessary to enable it to determine the application.

(8)

The Board shall determine an application by either—

(a)

granting the application; or

(b)

refusing the application.

(9)

The Board shall give notice in writing to the doctor of its determination and shall—

(a)

where it grants the application, include the doctor’s name in the child health surveillance list; or

(b)

where it refuses the application, inform him of the reasons for its determination and of his right to appeal under paragraph (10).

(10)

If an application is refused in accordance with paragraph (8)(b), the doctor may appeal in writing to the Department within 30 days of receiving notice in writing of the Board’s determination.

(11)

On any appeal pursuant to paragraph (10) or (15) the Department—

(a)

may, if it thinks fit, hold an oral hearing of the appeal and, in such a case, shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the Board;

(b)

in determining the appeal, shall either confirm or reverse the determination of the Board and shall communicate its decision in writing, together with the reasons for it, to the appellant and the Board;

(c)

where it reverses the determination of the Board, shall direct that the Board include the doctor’s name in the child health surveillance list.

(12)

Subject to paragraphs (13) to (17), a doctor’s name may be removed by the Board from the child health surveillance list if—

(a)

it has been removed from the medical list pursuant to regulation 5(3) or regulation 6; or

(b)

the Board has determined that the doctor has not provided child health surveillance services at any time during the past 5 years; or

(c)

the Board has determined that the doctor has not complied with the criterion set out in paragraph 2 of Part VII of Schedule 3 for continued inclusion in the child health surveillance list.

(13)

Before making any determination under sub-paragraph (b) or (c) of paragraph (12) the Board shall—

(a)

give the doctor 30 days' written notice of its intention to do so; and

(b)

afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the Board.

(14)

Where the Board makes a determination under sub-paragraph (b) or (c) of paragraph (12), it shall send to the doctor a notice which shall include a statement—

(a)

to the effect that, subject to any appeal to the Department under paragraph (15), the doctor’s name will, after 30 days from the date of the notice, be removed from the child health surveillance list;

(b)

of the Board’s reasons for its determination; and

(c)

of the doctor’s right of appeal under paragraph (15).

(15)

A doctor who has received a notice in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Department against the determination of the Board and, pending the determination of the appeal, the Board shall not remove his name from the child health surveillance list.

(16)

An appeal to the Department pursuant to paragraph (15) shall be made in writing and shall include a statement of the grounds of appeal and on any such appeal the Department shall, if it allows the appeal, direct that the Board shall not remove the doctor’s name from the child health surveillance list.

(17)

The Board shall comply with any direction given to it under this regulation.

(18)

Where the Department holds an oral hearing of an appeal pursuant to paragraph (11)(a), the appellant and the Board may be represented by counsel, solicitor or any other person.

Obtaining child health surveillance services27.

(1)

A parent may, in relation to a child of his who is under the age of 5 years, apply to a doctor—

(a)

who is—

(i)

the doctor on whose list the child is included (in this paragraph referred to as “the child’s doctor”);

(ii)

a doctor with whom the child’s doctor is in partnership; or

(iii)

a doctor with whom the child’s doctor is associated in a group practice; and

(b)

whose name is included in the medical list and in the child health surveillance list,

for the provision of child health surveillance services in respect of that child for a period ending on the date on which that child attains the age of 5 years.

(2)

A doctor whose name is included in the medical list may, in respect of any person on his list or on the list of a doctor with whom he is in partnership or with whom he is associated in a group practice, undertake to provide child health surveillance services, provided that—

(a)

his name is also included in the child health surveillance list; and

(b)

the person in question is a child who is under the age of 5 years.

(3)

A doctor who has undertaken, pursuant to paragraph (2), to provide child health surveillance services to any child shall, in respect of that child—

(a)

provide all the services described in paragraph 1 of Schedule 4 other than any examination so described which the parent refuses to allow the child to undergo, until the date upon which the child attains the age of 5 years;

(b)

maintain such records as are specified in paragraph 2 of that Schedule; and

(c)

furnish the Board with such information as is specified in paragraph 3 of that Schedule in accordance with the requirements of that paragraph.

(4)

An undertaking to provide child health surveillance services shall cease forthwith to be effective if—

(a)

either—

(i)

the parent informs the doctor; or

(ii)

the doctor informs the parent,

that he wishes the undertaking to have no further effect;

(b)

the child has been removed from the doctor’s list or from that of his partner or from that of a doctor with whom he is associated in a group practice, as the case may be, and has not been transferred to any other of those lists;

(c)

the parent—

(i)

has been invited to arrange for the child to attend for an examination referred to in paragraph 1(b) of Schedule 4; and

(ii)

fails within 42 days to respond to that invitation; or

(d)

any examination referred to in paragraph 1(b) of that Schedule is undertaken in respect of the child otherwise than by the doctor or a person acting on his behalf.

(5)

Where, in accordance with paragraph (4), an undertaking has ceased to be effective, the doctor shall forthwith—

(a)

in a case to which sub-paragraph (a), (c) or (d) of that paragraph applies, so inform the Board in writing; and

(b)

in a case to which sub-paragraph (c) or (d) of that paragraph applies, also so inform the parent in writing.

Obtaining contraceptive services28.

(1)

Whether or not she is included in his list for the provision of other personal medical services, a woman may apply to a doctor who has undertaken to provide contraceptive services to be accepted by him for the provision of those services.

(2)

An application under paragraph (1) shall be for the provision of contraceptive services for a term of 12 months from the date of acceptance, but either the woman or the doctor may terminate the provision at any time during that period.

(3)

On any such termination or at the end of the period of 12 months, as the case may be, the woman may apply (or re-apply) to a doctor in accordance with paragraph (1).

(4)

A woman may apply to a doctor who has undertaken to provide contraceptive services in an area in which she is temporarily resident, to be accepted by him for the provision to her, as a temporary resident, of contraceptive services.

(5)

Where a woman to whom paragraph (4) applies has been accepted by a doctor for the provision of contraceptive services, regulation 25(4) shall apply to her in relation to her inclusion in the list of patients in the area of her former residence for the provision of those services.

Obstetric Committee29.

(1)

The Department shall appoint, in accordance with Schedule 6, a committee to be known as the Obstetric Committee.

(2)

The Obstetric Committee shall, having regard to any general criteria drawn up for its guidance by the Department in consultation with such organisations as the Department may recognise as representing the medical profession, determine the conditions which are necessary for the inclusion and for the continued inclusion of a doctor’s name in the obstetric list as defined in accordance with regulation 31 or 32 and shall send copies of such conditions to each Board.

(3)

Copies of the conditions referred to in paragraph (2) shall be available for inspection at the offices of each Board, the office of the Agency and at such other places as appear to a Board to be convenient for informing all persons interested.

(4)

It shall be the duty of the Obstetric Committee to examine and determine all applications and cases referred to it by a Board under regulation 31(3) and regulation 32(2).

Obstetric list30.

(1)

Each Board shall prepare a list, to be called “the obstetric list”, of the doctors in its area who, having made an application under regulation 31, are accepted for inclusion of their names in the list.

(2)

The obstetric list shall contain in addition to the name of the doctor—

(a)

the address of any surgery and any other place at which he provides maternity medical services and any telephone number at which he is prepared to receive messages;

(b)

particulars of the days and hours at which he undertakes to be in attendance at each place or a statement to the effect that consultation will be by appointment;

(c)

the name of any doctor, whose name is also included in the obstetric list, with whom he is in partnership or who is acting as his assistant;

(d)

where he is acting as an assistant, the name and address of the principal by whom he is employed; and

(e)

if the Board thinks fit, details of the area in which the doctor undertakes to provide treatment.

(3)

A doctor whose name is included in the obstetric list shall, within 14 days, notify the Board of any change or addition affecting the entries which the obstetric list is required to contain in relation to him.

Admission to the obstetric list31.

(1)

Any doctor who wishes to have his name included in the obstetric list shall apply, (on a form approved by the Department and available from the Board) to the Board for the area in which his main practice premises are situated.

(2)

The Board shall examine each application submitted in accordance with paragraph (1) and, if satisfied that the application complies with the conditions determined by the Obstetric Committee in accordance with regulation 29(2), shall include that doctor’s name in the obstetric list and notify him accordingly.

(3)

Where the Board is not satisfied that an application complies with the conditions determined by the Obstetric Committee in accordance with regulation 29(2) it shall refer the application to that Committee which shall examine the application, decide whether or not it should be granted and the restrictions, if any, subject to which it should be granted.

(4)

The Obstetric Committee shall inform the Board of its decision on any application referred to it in accordance with paragraph (3) and the Board shall comply with the decision and notify the doctor accordingly.

(5)

The decision of the Obstetric Committee on any application referred to it in accordance with paragraph (3) shall be final.

Review of the obstetric list32.

(1)

At intervals of one year or such other period as the Department may determine, each Board shall examine the obstetric list in relation to its area and in every case in which it is satisfied that the conditions determined by the Obstetric Committee are complied with, shall notify each doctor concerned that his name has been retained on the obstetric list.

(2)

Where a Board, on examination of the obstetric list in relation to its area in accordance with paragraph (1), is not satisfied that the conditions determined by the Obstetric Committee in accordance with regulation 29(2) are complied with in the case of a doctor, the Board shall notify the doctor accordingly. If the doctor wishes his name to remain on the list, he shall request the Board to refer the matter to the Obstetric Committee and may, at the same time, make written representations to that Committee which shall decide whether or not his name should be retained on the obstetric list and inform the Board accordingly.

(3)

The Board shall comply with the decision of the Obstetric Committee under paragraph (2) and shall notify the doctor and the Agency accordingly.

(4)

In any case referred to it under paragraph (2), the decision of the Obstetric Committee as to whether or not the name of a doctor should be retained on the obstetric list shall be final.

Removal from the obstetric list33.

(1)

A doctor’s name shall be removed from the obstetric list only if—

(a)

it has been removed from the medical list pursuant to regulation 6; or

(b)

the Board is satisfied that he has never provided, or has ceased to provide, maternity medical services; or

(c)

the Obstetric Committee has decided under regulation 32(2) that his name should not be retained on that list.

(2)

On the removal of a doctor’s name from the obstetric list, the Agency shall give each woman for whom he has undertaken to provide maternity medical services notice of her right to apply to another doctor for the provision of such services in accordance with regulation 34.

Obtaining maternity medical services34.

(1)

Maternity medical services shall comprise—

(a)

the provision of personal medical services to a woman during the ante-natal period;

(b)

the provision of personal medical services to a woman during labour;

(c)

the provision of personal medical services to a woman and to her baby, as specified in paragraph 3(b) of Schedule 5, during the post-natal period; and

(d)

the provision of a full post-natal examination.

(2)

A woman who holds a current medical card and who, after a doctor has diagnosed that she is pregnant, requires the provision of maternity medical services, may apply for the provision of any or all of the services mentioned in paragraph (1) to any doctor whose name is included in the obstetric list and an application under this paragraph shall be made in writing on a form provided by the Agency and issued by the doctor.

(3)

A woman who has already been accepted as a patient by a doctor to whom she has applied in accordance with paragraph (2) but who is residing temporarily outside his practice area, may apply to any doctor whose name is included in the obstetric list in the area in which she is temporarily resident for the provision of such services as she may require during her period of temporary residence.

(4)

A doctor with whom a woman has made an arrangement under paragraph (2) or (3) for the provision of any or all of the services mentioned in paragraph (1) shall provide such services as are specified in Schedule 5.

(5)

The provisions of regulation 19 shall apply to the making of an arrangement by a woman with a doctor for the provision of any or all of the services mentioned in paragraph (1) as they apply to the making of an application for inclusion in a doctor’s list.

(6)

An arrangement between a woman and a doctor for the provision of any or all of the services mentioned in paragraph (1) shall be terminated—

(a)

by the woman—

(i)

so notifying the Board in writing;

(ii)

so notifying the doctor in writing who shall notify the Board in writing; or

(iii)

making a new arrangement with another doctor who shall notify the Board in writing within 7 days of the making of the new arrangement;

(b)

by the doctor making an application under paragraph 12 of the terms of service; or

(c)

where the woman is a temporary resident, when—

(i)

she ceases to be resident in the doctor’s practice area; or

(ii)

the doctor’s responsibility for her is terminated under paragraph 11 of the terms of service,

whichever first occurs.

(7)

Where the Board receives notification in accordance with paragraph (6)(a)(i) or (iii), it shall within 7 days notify the original doctor in writing that the woman’s arrangement with him has been terminated.

Minor surgery list35.

(1)

Each Board shall maintain a list (in these regulations referred to as “the minor surgery list”) of the names of those doctors in its area who have satisfied it or, on appeal, the Department, in accordance with the following provisions of this regulation, that they have such medical experience, training and facilities as are necessary to enable them properly to provide all of the procedures listed in Schedule 7.

(2)

A doctor may apply, in accordance with paragraph (3), to the Board for the area in which his main practice premises are situated for the inclusion of his name in the minor surgery list.

(3)

An application for the purpose of paragraph (2) shall be made in writing and shall include the information specified in Part VIII of Schedule 3.

(4)

Unless the doctor otherwise agrees, the Board shall determine an application made in accordance with paragraph (3) within 2 months of receiving it.

(5)

The Board may hold an oral hearing of any application and shall not refuse an application without giving the doctor an opportunity of an oral hearing.

(6)

Where the Board decides to hold an oral hearing, it shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the doctor.

(7)

When determining an application, the Board shall have regard—

(a)

for the purpose of assessing the doctor’s medical experience, to—

(i)

any postgraduate qualification held by him relevant to the provision of minor surgery services;

(ii)

the criteria listed in paragraph 1 of Part IX of Schedule 3;

(b)

for the purpose of assessing the doctor’s facilities, to the checklist in paragraph 3 of Part IX of Schedule 3 regarding the premises and the equipment to be used by the doctor in the provision of minor surgery services,

and shall seek and take into account any medical advice it considers necessary to enable it to determine the application.

(8)

The Board shall determine an application by either—

(a)

granting the application; or

(b)

refusing the application.

(9)

The Board shall inform the doctor in writing of its determination and shall—

(a)

where it grants the application in accordance with paragraph (8)(a), include the doctor’s name in the minor surgery list; or

(b)

where it refuses the application in accordance with paragraph (8)(b), give notice in writing to him of the reasons for the determination and of his right of appeal under paragraph (10).

(10)

If an application is refused in accordance with paragraph (8)(b), the doctor may appeal in writing to the Department within 30 days of receiving notice in writing of the Board’s determination.

(11)

On any appeal pursuant to paragraph (10) or (15), the Department—

(a)

may hold an oral hearing of the appeal and shall, not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and the Board;

(b)

in determining the appeal, shall either confirm or reverse the determination of the Board and shall communicate its decision in writing, together with the reasons for it, to the appellant and the Board; and

(c)

where it reverses the determination of the Board, shall direct that the Board include the doctor’s name in the minor surgery list.

(12)

Subject to paragraphs (13) to (17), a doctor’s name may be removed from the minor surgery list if—

(a)

it has been removed from the medical list pursuant to regulation 6;

(b)

the Board has determined that the doctor has not provided minor surgery services at any time during the past 5 years; or

(c)

the Board has determined that the doctor has not complied with the criteria listed in paragraph 2 of Part IX of Schedule 3 for continued inclusion of his name in the minor surgery list.

(13)

Before making any determination under sub-paragraph (b) or (c) of paragraph (12), the Board shall—

(a)

give the doctor 30 days' written notice of its intention to do so; and

(b)

afford the doctor an opportunity of making representations in writing or, if he so desires, orally to the Board.

(14)

Where the Board makes a determination under sub-paragraph (b) or (c) of paragraph (12), it shall send to the doctor a notice which shall include a statement—

(a)

to the effect that, subject to any appeal under paragraph (15), the doctor’s name will, after 30 days from the date of the notice, be removed from the minor surgery list;

(b)

of the Board’s reasons for its determination; and

(c)

of the doctor’s right of appeal under paragraph (15).

(15)

A doctor who has received a notice sent in accordance with paragraph (14) may, within 21 days of receiving it, appeal to the Department against the determination and, pending the determination of the appeal, the Board shall not remove his name from the minor surgery list.

(16)

An appeal to the Department under paragraph (15) shall be made in writing and shall include a statement of the grounds of appeal and on any such appeal the Department shall, if it allows the appeal, direct that the Board shall not remove the doctor’s name from the minor surgery list.

(17)

The Board shall comply with any direction given to it under this regulation.

(18)

Where the Department holds an oral hearing of an appeal pursuant to paragraph (11)(a), the appellant and the Board may be represented by counsel, solicitor or any other person.

Obtaining minor surgery services36.

(1)

A person may apply, either in writing or in person, to a doctor—

(a)

who is—

(i)

the doctor in whose list he is included (in this paragraph referred to as “his own doctor”);

(ii)

a doctor with whom his own doctor is in partnership; or

(iii)

a doctor with whom his own doctor is associated in a group practice; and

(b)

whose name is included in the medical list and the minor surgery list,

for the provision of a procedure specified in Schedule 7 and the provisions of regulation 19 shall apply to that application as if the reference in regulation 19 to an application to a doctor for inclusion in his list were a reference to an application to a doctor for minor surgery services.

(2)

A doctor whose name is included in the medical list and the minor surgery list may, in respect of any person on his list or on the list of a doctor with whom he is in partnership or with whom he is associated in group practice, undertake to provide minor surgery services.

(3)

A doctor who has undertaken, pursuant to paragraph (2), to provide minor surgery services in respect of any patient shall offer to provide any of the procedures described in Schedule 7 which it is, in his opinion, appropriate for him to provide in the case of that patient.

(4)

Where a doctor provides minor surgery services in respect of a patient who is not included on his list, he shall inform in writing the doctor on whose list the patient is included of the outcome of the procedure.

(5)

Nothing in this regulation shall prevent any doctor personally performing, in the course of providing general medical services (otherwise than by minor surgery services) to a patient, a procedure described in Schedule 7.

Part VPayments to doctors

Payments37.

(1)

The Board and the Agency shall make payments to doctors with whom arrangements for the provision of general medical services exist, in accordance with such rates and subject to such conditions as the Department may determine and publish in a Statement, after consultation with such organisations as may be recognised by the Department as representing doctors with whom arrangements for the provision of general medical services exist, and with the consent of the Department of Finance and Personnel, so as to secure compliance with section 8 of, and Schedule 2 to, the Finance Act (Northern Ireland) 197126.

(2)

The determination under paragraph (1) shall make provision for the following matters—

(a)

basic practice allowance, and additional allowances for seniority and employment of assistants;

(b)

standard capitation fees and capitation fees for elderly patients;

(c)

fees for items of service, maternity medical services and temporary residents;

(d)

fees and allowances for the supply of drugs and appliances and for rural practice;

(e)

allowances for training doctors and for study leave;

(f)

allowances for initial practice or to maintain practice viability;

(g)

allowances to maintain practice viability for essential medical practices in isolated rural areas;

(h)

allowances for practice expenses and, in particular, allowances for practice staff, including any who are spouses or other relatives;

(i)

allowances for improvement of premises;

(j)

such other payments or arrangements in respect of practice expenses or practice improvements as may be determined by the Department with the consent of the Department of Finance and Personnel;

(k)

fees for contraceptive services;

(l)

payments in relation to the making of arrangements for, and payments for, the temporary provision of general medical services;

(m)

capitation fees in respect of patients who participate in a consultation pursuant to paragraph 16 of the terms of service;

(n)

capitation fees in respect of patients to whom child health surveillance services are provided;

(o)

capitation fees in respect of patients living in a deprived area;

(p)

fees for minor surgery sessions undertaken;

(q)

payments in respect of health promotion programmes approved by the Board;

(r)

payments in respect of disease management programmes approved by the Board;

(s)

target payments in respect of immunisations provided;

(t)

target payments in respect of cervical cytology;

(u)

allowances for the employment of locums by doctors during maternity leave, sickness or study leave;

(v)

allowances for undergoing approved post-graduate education;

(w)

allowances for the employment of doctors by isolated single-handed doctors;

(x)

allowances in respect of providing placements in the practice for undergraduate medical students;

(y)

transitional payments in consequence of changes to doctors' terms of service.

(3)

The determination under paragraph (1) may be amended from time to time by the Department after consultation with the organisations referred to in that paragraph and with the consent of the Department of Finance and Personnel and any amendments shall also be published in a Statement.

(4)

In this regulation “deprived area” means a ward of a local government district (within the meaning of section 1 of the Local Government Act (Northern Ireland) 197227) listed in the Statement referred to in paragraph (1).

Payments to suspended doctors38.

(1)

The Board and the Agency shall make payments to any doctor who is suspended by direction of the Tribunal (“the suspended doctor”) in accordance with the Department’s determination in relation to such payments.

(2)

The Department shall make the determination in accordance with paragraph (3) after consultation with the organisations referred to in regulation 37(1) and publish it with the Statement referred to in that regulation.

(3)

The determination may be amended from time to time by the Department, after consultation with the organisations referred to in regulation 37(1) and any amendments shall also be published with the Statement referred to in that regulation.

(4)

Subject to paragraphs (5) and (6), the Department’s determination shall be such as to secure that, as far as reasonably practicable, the suspended doctor receives all the payments which would have been due to him pursuant to regulation 37 had he provided such general medical services to his patients

during the period of his suspension as are actually provided by the doctor who becomes responsible for them during that period by virtue of regulation 24(2).

(5)

To the extent that such payments consist of the reimbursement of expenses for which a doctor must submit a claim, the suspended doctor shall receive reimbursement only in respect of those expenses which he continues to incur during the period of his suspension.

(6)

In a case to which paragraph 8B(3) of Part I of Schedule 11 to the Order28 applies, the determination shall provide for a deduction to take account of any payments which the suspended doctor receives for providing general medical services as an assistant or deputy.

Claims and overpayments39.

(1)

Any claim for fees, allowances or other remuneration by a doctor shall be made in accordance with the provisions of the Statement under regulation 37.

(2)

Where a Board or the Agency considers that a payment has been made to a doctor in circumstances when it was not due, it shall, except to the extent that the Department, on the Board’s or the Agency’s application, directs otherwise, draw the overpayment to his attention and—

(a)

where the overpayment is admitted by him; or

(b)

where the overpayment is not so admitted but the matter having been referred under regulation 5(1) of the Disciplinary Procedures Regulations for investigation, the Board or the Agency, or the Department on appeal under regulation 9(1)(c) of those Regulations, decides that there has been an overpayment,

the overpayment shall be recoverable either by deduction from the doctor’s remuneration or in some other manner.

(3)

Recovery of an overpayment under this regulation shall be without prejudice to the investigation of an alleged breach of the terms of service.

Part VIMiscellaneous

Determination of question of whether a substance is a drug, and recovery of cost40.

(1)

Any question as to whether a substance supplied or ordered by a doctor for provision by a chemist is a drug, the provision of which formed part of pharmaceutical services provided under the Order, shall be determined under the provisions of this regulation.

(2)

Where it appears to a Board, having been notified by the Agency, that a question arises under paragraph (1), the Board shall—

(a)

notify in writing the doctor who supplied or ordered the substance of the nature of the question arising; and

(b)

invite him to state in writing, within 30 days from the date on which the notice was sent to him, whether he wishes the question to be referred to the Local Medical Committee for its opinion.

(3)

The Board—

(a)

shall, where the doctor states that he wishes the question to be referred to the Local Medical Committee for its opinion, refer the question accordingly;

(b)

in any other case, may refer the question to the Local Medical Committee for its opinion; and

(c)

may, in any event, seek such medical or pharmaceutical advice as it thinks fit, otherwise than from the Local Medical Committee.

(4)

Where the question is referred to the Local Medical Committee under the provisions of paragraph (3), that Committee shall—

(a)

furnish the doctor concerned with a statement indicating the nature of the question referred to it by the Board; and

(b)

give the doctor concerned a reasonable opportunity to—

(i)

submit to the Local Medical Committee any statement in writing; and

(ii)

appear before it and be heard by it, in connection with the question so referred.

(5)

The Local Medical Committee shall—

(a)

in forming its opinion under this regulation, have regard to any information or evidence provided by the Board or the Agency in connection with the question referred to it; and

(b)

inform the doctor and the Board, in writing, of its opinion, its findings of fact and its reasons for its opinion.

(6)

The Board shall—

(a)

send notice of the question, in writing, to—

(i)

the doctor who supplied or ordered the substance;

(ii)

the person to whom the order was given; and

(iii)

any other person who, in the opinion of the Board, has an interest in the determination of the question; and

(b)

invite any such person to submit to the Board his comments, in writing, on that question within 30 days or within such further period as the Board may, for reasonable cause, allow.

(7)

The Board shall, in determining the question, have regard to any opinion obtained by it under any of the provisions of paragraphs (3) to (5), and shall—

(a)

send notice of its decision, in writing, to—

(i)

the doctor concerned;

(ii)

the Local Medical Committee; and

(iii)

any person who submitted comments under paragraph (6); and

(b)

where it determines that the substance in question is not a drug the provision of which forms part of pharmaceutical services, inform the doctor of his right of appeal under paragraph (8).

(8)

Where the Board has determined that the substance in question is not a drug the provision of which forms part of pharmaceutical services, the doctor may appeal to the Department by giving notice of appeal within 30 days from the date on which the notice of the decision was sent to him or within such longer period as the Department may, for reasonable cause, allow.

(9)

Any notice of appeal given under this regulation shall be given in writing and shall contain a concise statement of the grounds of appeal.

(10)

The Department shall send a copy of the notice of appeal to the Board and to any person who submitted comments to the Board under paragraph (6).

(11)

Any person to whom a copy of the notice of appeal is sent pursuant to paragraph (10), may, within 30 days from the date on which the notice was sent to him, make representations in writing to the Department on the appeal.

(12)

The Department shall require an oral hearing of the appeal and shall nominate up to 3 persons to hear the appeal, of whom—

(a)

at least one is a medical practitioner; and

(b)

none are officers of the Department.

(13)

An oral hearing shall take place at such time and place as the Department may direct, and notice of the hearing shall be sent, not less than 14 days before the date fixed for the hearing, to the doctor and to any person who received a copy of the notice of appeal under paragraph (10).

(14)

The doctor and any person mentioned in paragraph (10) may attend and be heard in person or by counsel, solicitor or other representative and the Board may be represented at the hearing by any duly authorised officer or member, or by counsel or solicitor.

(15)

The persons nominated by the Department under paragraph (12) shall determine the procedure at the oral hearing as they see fit and, on determining the appeal, shall either—

(a)

allow the appeal; or

(b)

confirm the decision of the Board,

and shall inform the Department of their findings of fact.

(16)

The Department shall, as soon as practicable, send to the doctor and to any person mentioned in paragraph (10) notice in writing of its decision on the appeal and shall include in the notice a statement of its reasons for the decision and of its findings of fact.

(17)

Where the Board or, on appeal, the Department has determined that a substance is not a drug the provision of which forms part of pharmaceutical services provided under the Order, the Board shall recover from the doctor who, or whose deputy or assistant, supplied or ordered the substance, by deduction from his remuneration or otherwise, an amount calculated in accordance with paragraph (19).

(18)

Any amount determined as being recoverable under this regulation shall be a debt owing by the doctor to the Board.

(19)

For the purposes of paragraph (18), the amount to be recovered in respect of the supply of any substance shall be the cost of that substance to the Board, including the dispensing fee payable in respect of the preparation in accordance with the Drug Tariff published under regulation 9 of the Pharmaceutical Regulations, and where the substance was an ingredient in a preparation of which other ingredients were drugs, the amount to be recovered shall be the cost of that substance to the Board together with one-half of the amount of the dispensing fee payable in respect of the supply of the preparation.

Publication of particulars41.

(1)

Each Board shall publish the local directory and shall make available for inspection at its principal office copies of—

(a)

the local directory;

(b)

a compendium of practice leaflets provided to it by doctors whose names are included in the medical list;

(c)

the terms of service; and

(d)

the Statement published under regulation 37,

and shall keep them up to date.

(2)

The Agency shall publish the medical list and the obstetric list and shall make copies of them available for inspection at its office together with a copy of the Statement published under regulation 37 and shall keep them up to date.

(3)

The Board and the Agency shall make the documents mentioned in paragraphs (1) and (2) available for inspection at such other places as appear to them convenient for informing all persons interested or may publish at such places a notice of the places and times at which copies of such documents may be seen.

(4)

The Agency shall—

(a)

send a copy of the medical list and the obstetric list to the Department, each Board, the Medical Committee, the Obstetric Committee, the Local Pharmaceutical Committee, each Local Medical Committee and the General Medical Services Committee of the British Medical Association; and

(b)

at intervals of not more than 3 months notify each of the bodies mentioned in sub-paragraph (a) of any alterations in the lists mentioned in that sub-paragraph.

(5)

Notwithstanding paragraph (4), if the Agency considers that only parts of the medical list or the obstetric list, or that only some of the alterations, are likely to concern the bodies mentioned in that paragraph, it may send to those bodies a copy of only those parts or alterations.

Appointment of medical adviser42.

A Board shall appoint a doctor to assist it in the exercise of its functions pursuant to paragraph 55 of the terms of service for doctors (inquiries about prescriptions and referrals).

Guidance to doctors43.

(1)

A Board may issue guidance to doctors whose names are included in the medical list to assist them in assessing, in accordance with paragraph 35 of the terms of service, the qualifications, experience and competence of any employee or prospective employee.

(2)

Any guidance issued for the purposes of paragraph (1) in connection with the employment of members of any profession or other occupational group shall have regard to any statement as to minimum professional standards of conduct published by any body responsible for the regulation of that profession or occupational group.

Revocations44.

(1)

Regulation 3 of the Central Services Agency Committees (Amendment) Regulations (Northern Ireland) 198929 is hereby revoked

(2)

The Regulations specified in Schedule 15 are hereby revoked.

Sealed with the Official Seal of the Department of Health and Social Services on

Joan Dixon
Assistant Secretary

Sealed with the Official Seal of the Department of Finance and Personnel on

D. Thomson
Assistant Secretary