xmlns:atom="http://www.w3.org/2005/Atom"

Statutory Rules of Northern Ireland

1997 No. 380

HEALTH AND PERSONAL SOCIAL SERVICES

General Medical Services Regulations (Northern Ireland) 1997

Made

15th August 1997

Coming into operation

6th October 1997

The Department of Health and Social Services, in exercise of the powers set out in Schedule 1 and of all other powers enabling it in that behalf, and in conjunction with the Department of Finance and Personnel and after consultation with such organisations as appear to the Department to be representative of the medical profession as required by Article 56(5) of the Health and Personal Social Services (Northern Ireland) Order 1972(1), hereby makes the following Regulations:

Part IGeneral

Citation and commencement

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

Interpretation

2.  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) 1996(2);

“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 Order(3);

“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 1983(4);

“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 Order(5);

“Pharmaceutical Regulations” means the Pharmaceutical Services Regulations (Northern Ireland) 1997(6);

“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 1992(7);

“relevant service” has the same meaning as in section 64(1) of the Reserve and Auxiliary Forces (Protection of Civil Interests) Act 1951(8) as extended to Northern Ireland by the Reserve and Auxiliary Forces (Protection of Civil Interests) (Northern Ireland) Order 1979(9) and includes services rendered under the Reserve Forces Act 1980(10) and the Reserve Forces Act 1996(11);

“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 Order(12) 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) 1968(13);

“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) 1968(14) 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 service

3.—(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 Order(15) 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 list

4.—(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 list

5.—(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 list

6.—(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 Order(17) (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 Committee

7.  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 vacancies

8.—(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 vacancy

9.—(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 Order(18) (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 partnership

10.—(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 principal

11.—(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 list

12.—(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 provided

13.  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 conditions

14.—(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 Department

15.—(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 doctors

16.—(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 1983(19) 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 directory

17.—(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' lists

18.—(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 services

19.—(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) 1970(20) 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 1995(21), 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 doctors

20.—(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 doctor

21.—(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 list

22.—(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' lists

23.—(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 services

24.—(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 1983(22), 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 1978(23).

(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 residents

25.—(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) 1970(25) 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 list

26.—(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 services

27.—(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 services

28.—(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 Committee

29.—(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 list

30.—(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 list

31.—(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 list

32.—(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 list

33.—(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 services

34.—(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 list

35.—(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 services

36.—(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

Payments

37.—(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) 1971(26).

(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) 1972(27)) listed in the Statement referred to in paragraph (1).

Payments to suspended doctors

38.—(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 Order(28) 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 overpayments

39.—(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 cost

40.—(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 particulars

41.—(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 adviser

42.  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 doctors

43.—(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.

Revocations

44.—(1) Regulation 3 of the Central Services Agency Committees (Amendment) Regulations (Northern Ireland) 1989(29) 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

L.S.

Joan Dixon

Assistant Secretary

15th August 1997.

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

L.S.

D. Thomson

Assistant Secretary

15th August 1997.

SCHEDULE 1Provisions Conferring Powers Exercised in Making these Regulations

Column 1Column 2
ProvisionRelevant amendments
The Health and Personal Social Services (Northern Ireland) Order 1972(30)
Article 55(3)None.
Article 56(1), (2), (3), (3A), (4), (4B) and (5)
  • The Health and Personal Social Services (Northern Ireland) Order 1978(31) Article 12;

  • The European Communities (Medical, Dental and Nursing Professions) (Linguistic Knowledge) Order 1981(32), Article 5(1);

  • The Health and Personal Social Services and Public Health (Northern Ireland) Order 1986(33), Article 7;

  • The Health and Medicines (Northern Ireland) Order 1988(34), Article 4(5);

  • The Health and Personal Social Services (Northern Ireland) Order 1991(35), Article 29(1) and Schedule 6; and

  • The Medical (Professional Performance) Act 1995(36), section 4 and paragraph 30(a) and (b) of the Schedule.

Article 64(1)
  • The Health and Personal Social Services (Amendment) (Northern Ireland) Order 1986(37), Article 5(2); and

  • The Health and Personal Social Services (Northern Ireland) Order 1991, Article 31(2)

Article 95None
Article 106(b)None
Article 107(6)None
Schedule 3, paragraph 7None
The Health and Medicines (Northern Ireland) Order 1988
Article 4(1) and (4)None
Article 10(1) and (2)None

Regulation 3(2)

SCHEDULE 2Terms of Service for Doctors

  1. 1.Interpretation

  2. 2.General

  3. 3-4.A doctor’s patients

  4. 5-8.Acceptance of patients

  5. 9-12.Termination of responsibility for patients

  6. 13.Services to patients

  7. 14-15.Provision of services to patients during and outside normal hours

  8. 16.Newly registered patients

  9. 17.Patients not seen within 3 years

  10. 18.Patients aged 75 years or over

  11. 19-31.Transfer of responsibility, absences, deputies, assistants and partners

  12. 32.Practice premises

  13. 33-34.Arrangements at practice premises

  14. 35.Employees

  15. 36.Doctors' availability to patients

  16. 37.Availability to patients outside normal hours

  17. 38.Doctors available for only 4 days a week

  18. 39.Practice area

  19. 40.Notification of change of place of residence

  20. 41.Records

  21. 42.Certification

  22. 43-47.Fees

  23. 48-50.Prescribing

  24. 51.Practice leaflet

  25. 52-53.Complaints

  26. 54.Reports to medical officer of the Department

  27. 55.Inquiries about prescriptions and referrals

  28. 56.Annual reports

  29. 57.Incorporation of provisions of Regulations etc

Interpretation

1.  In this Schedule—

“appliance” means an appliance which is included in a list for the time being approved by the Department for the purposes of Article 63 of the Order(38);

“assistant” includes a trainee general practitioner;

“chemical reagent” means a chemical reagent which is included in a list for the time being approved by the Department for the purposes of Article 63 of the Order;

“deputy” means a person to whom a doctor has, under paragraph 20, delegated the treatment of his patients;

“drug” includes medicine;

“Drug Tariff” means the statement published under regulation 9 of the Pharmaceutical Regulations;

“notice” means notice in writing;

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

“prescription form” means a form provided by the Agency and issued by a doctor to enable a person to obtain pharmaceutical services as defined by Article 63(1) of the Order;

“the Regulations” means the General Medical Services Regulations (Northern Ireland) 1997;

“Scheduled drug” means a drug or other substance specified in Schedule 10 or, except where the conditions in paragraph 45(2) are satisfied, in Schedule 11;

“single-handed practice” means a practice in which only one doctor is engaged.

General

2.  Where a decision whether any, and if so what, action is to be taken under these terms of service requires the exercise of professional judgement, a doctor shall not, in reaching that decision, be expected to exercise a higher degree of skill, knowledge and care than—

(a)in the case of a doctor providing child health surveillance services under regulation 27, maternity medical services under regulation 34 or minor surgery services under regulation 36, that which any general practitioner whose name is included in the child health surveillance list, the obstetric list or, as the case may be, the minor surgery list may reasonably be expected to exercise; and

(b)in any other case, that which general practitioners as a class may reasonably be expected to exercise.

A doctor’s patients

3.—(1) Subject to sub-paragraph (2) and to paragraphs 9, 10, 11 and 12, a doctor’s patients are—

(a)persons who are recorded by the Agency as being on his list;

(b)persons whom he has accepted or agreed to accept for inclusion in his list, whether or not notification of that acceptance has been received by the Agency, and who have not been notified to him by the Agency as having ceased to be on his list;

(c)for the limited period specified in sub-paragraphs (4) and (5), persons whom he has refused to accept for inclusion in his list;

(d)persons who have been assigned to him under regulation 20;

(e)for the limited period specified in sub-paragraph (6), persons in respect of whom he has been notified that an application has been made for assignment to him in a case to which regulation 20(3)(b) applies;

(f)persons whom he has accepted for inclusion in his list as temporary residents;

(g)in respect of services under paragraph 8, persons to whom he has agreed to provide those services;

(h)persons to whom he may be requested to give treatment which is immediately required owing to an accident or other emergency at any place in his practice area, provided that—

(i)he is not, at the time of the request, relieved of liability to give treatment under paragraph 4; and

(ii)he is not, at the time of the request, relieved under paragraph 23(2) of his obligation to give treatment personally; and

(iii)he is available to provide such treatment,

and any persons by whom he is requested, and agrees, to give treatment which is immediately required owing to an accident or other emergency at any place in his practice area, provided there is no doctor who, at the time of the request, is under an obligation otherwise than under this head to give treatment to that person, or there is such a doctor but, after being requested to attend, he is unable to attend and give treatment immediately required;

(i)persons in relation to whom he is acting as deputy for another doctor under these terms of service;

(j)during the period of an appointment under regulation 24, persons whom he has been appointed to treat temporarily;

(k)in respect of child health surveillance services, contraceptive services, maternity medical services or minor surgery services, persons for whom he has undertaken to provide such services; and

(l)any person for whom he has accepted responsibility under an arrangement made under paragraph 20(2).

(2) Except in a case to which head (h), (i) or (j) of sub-paragraph (1) applies, a person shall not be a patient for the purposes of that sub-paragraph if a doctor has been notified by the Agency that he is no longer responsible for the treatment of that person.

(3) Where a person applies to a doctor for treatment and claims to be on that doctor’s list, but fails to produce his medical card on request and the doctor has reasonable doubts about that person’s claim, the doctor shall give any necessary treatment and shall be entitled to demand and accept a fee accordingly under paragraph 43(e), subject to the provision for repayment contained in paragraph 44. A doctor shall not order any drug or appliance on one of the order forms provided by the Agency so as to enable the person to obtain a drug or appliance as part of pharmaceutical services.

(4) Where a doctor—

(a)refuses to accept for inclusion in his list a person who lives in his practice area and who is not included in the list of another doctor practising in that area; or

(b)refuses to accept for inclusion in his list as a temporary resident a person to whom regulation 25 applies;

(c)has requested the removal with immediate effect of a person from his list in accordance with paragraph 10,

he shall on request give that person any immediately necessary treatment until the expiry of the period of 14 days beginning with the date when that person was refused acceptance (or, as the case may be, with the date when he requested the immediate removal of that person from his list), or until that person has been accepted by or assigned to another doctor, whichever occurs first.

(5) Where a doctor on the obstetric list refuses to provide maternity medical services in the case of a woman who applies to him for such services in accordance with regulation 34(2) or (3) and who is residing in the area within which the doctor has undertaken to provide maternity medical services, he shall, unless he is satisfied that she is already receiving maternity medical services from any other doctor in the area—

(a)give without charge to her such treatment including the supply of drugs and appliances, as may be immediately necessary, pending her acceptance for inclusion in the list of another doctor; and

(b)inform her of the name and place of attendance of any neighbouring doctor whose name is included in the obstetric list to whom application might be made and of the address of the nearest ante-natal clinic.

(6) Where the Agency has notified a doctor that it is applying for the Department’s consent under regulation 20(3)(b), the doctor shall give the person proposed for assignment any immediately necessary treatment until the Agency has notified him that—

(a)the Department has determined whether or not the person is to be assigned to that doctor; and

(b)either the person has been accepted by, or assigned to, another doctor or another doctor has been notified that an application has been made, in a case to which regulation 20(3)(b) applies, to assign that person to him.

(7) Nothing in this paragraph shall require a doctor to be responsible for the treatment in hospital of a person admitted to that hospital unless—

(a)he is a member of staff of the hospital and the terms of his appointment allow him to provide—

(i)general medical services (other than maternity medical services); or

(ii)in the case of a doctor whose name is included in the obstetric list, maternity medical services; or

(b)the hospital concerned, or part of that hospital, is one in which patients are entitled to secure treatment by their own doctor, whether or not such doctor is a member of staff of that hospital.

4.  A doctor who is elderly or infirm or who has been exempted by the Agency under regulation 20(5) from the liability to have persons assigned to him may be relieved by the Board of any liability to give treatment which is immediately required owing to an accident or other emergency between 7 pm on weekdays and 8 am on the following morning and between 1 pm on Saturday and 8 am on the following Monday to persons who are neither—

(a)on his list; nor

(b)temporary residents for whom he is responsible; nor

(c)accepted for inclusion in his list for the provision of maternity medical services.

Acceptance of patients

5.—(1) Subject to sub-paragraph (2), a doctor may agree to accept a person for inclusion in his list if the person is eligible to be so accepted by him.

(2) Where a doctor is responsible for treating the patients of another doctor whose name has been removed from the medical list, he may not consent to the transfer of any of those patients under regulation 21 to his own list or to that of his partner.

(3) Where a doctor has agreed to accept a person for inclusion in his list he shall, within 14 days of receiving that person’s medical card or form of application, or as soon after the expiry of that period as is practicable—

(a)sign the medical card or, as the case may be, the form of application; and

(b)send it to the Agency.

(4) Where, for the purposes of sub-paragraph (3), any person signs a medical card or form of application on behalf of a doctor he shall, in addition to his own signature, specify the name of the doctor on whose behalf he is signing.

6.  A doctor may—

(a)undertake to provide contraceptive services to a woman who has applied to him in accordance with regulation 28;

(b)accept for inclusion in his list as a temporary resident a person who has applied to him in accordance with regulation 25(1);

(c)if his name is on the obstetric list, undertake to provide maternity medical services to a woman who has made an arrangement with him in accordance with regulation 34(2) or (3).

7.  Notwithstanding that the person concerned is not on his list, a doctor may—

(a)take a cervical smear from a woman who would be eligible for acceptance by him for inclusion in his list as a temporary resident or for whom he has undertaken to provide maternity medical services or contraceptive services; and

(b)vaccinate or immunise a person who would be eligible for acceptance by him for inclusion in his list as a temporary resident.

8.  Where a doctor whose name is included in the obstetric list undertakes to provide maternity medical services required by a woman who applies to him in accordance with regulation 34(2) or (3), he shall advise the Board of the arrangement in such a form as it may require.

Termination of responsibility for patients

9.—(1) Subject to paragraph 10, a doctor may have any person removed from his list and shall notify the Agency in writing that he wishes to have a person removed from his list and, subject to sub-paragraph (2), the removal shall take effect—

(a)on the date on which the person is accepted by or assigned to another doctor; or

(b)on the eighth day after the Agency receives the notice,

whichever is the sooner.

(2) Where, at the date when the removal would take effect under sub-paragraph (1), the doctor is treating the person at intervals of less than 7 days, the doctor shall inform the Agency in writing of the fact and the removal shall take effect—

(a)on the eighth day after the Agency receives notification from the doctor that the person no longer needs such treatment; or

(b)on the date on which the person is accepted by or assigned to another doctor,

whichever is the sooner.

10.—(1) Where—

(a)a person on a doctor’s list has committed an act of violence against that doctor or has behaved in such a way that that doctor has feared for his safety; and

(b)that doctor has reported the incident to the police,

that doctor may notify the Agency that he wishes to have that person removed from his list with immediate effect.

(2) Notification under sub-paragraph (1) may be given by any means, including telephone or fax, but, if not given in writing, shall subsequently be confirmed in writing within 7 days (and, for the purpose of this paragraph, a notification given by fax is not a notification given in writing).

(3) The time at which the doctor notifies the Agency shall be the time at which he makes the telephone call or sends or delivers the notification to the Agency.

(4) Where, pursuant to this paragraph, a doctor has notified the Agency that he wishes to have a person’s name removed from his list with immediate effect, he shall take all reasonable steps to inform the person concerned.

11.  Where a doctor informs the Agency, in writing, that he wishes to terminate his responsibility for a temporary resident, his responsibility for that person shall cease in accordance with paragraph 9, as if the temporary resident were a person on his list.

12.—(1) A doctor with whom an arrangement has been made for the provision of any or all of the maternity medical services mentioned in regulation 34(1)(a) may agree with the woman concerned to terminate the arrangement and, in default of agreement, the doctor may apply to the Board for permission to terminate the arrangement.

(2) On an application under sub-paragraph (1), the Board, after considering any representations made by either party and after consulting the Local Medical Committee, may terminate the arrangement.

(3) Where a doctor ceases to provide any or all of the maternity medical services mentioned in regulation 34(1)(a), he shall inform any woman for whom he has arranged to provide such services that he is ceasing to provide them and that she may make a fresh arrangement to receive those services from another doctor.

Services to patients

13.—(1) Subject to paragraphs 2, 16 and 49, a doctor shall render to his patients all necessary and appropriate personal medical services of the type usually provided by general practitioners.

(2) The services which a doctor is required by sub-paragraph (1) to render shall include the following—

(a)giving advice, where appropriate, to a patient in connection with the patient’s general health and, in particular, about the significance of diet, exercise, the use of tobacco, the consumption of alcohol and the misuse of drugs or solvents;

(b)offering to patients consultation and, where appropriate, physical examination for the purpose of identifying, or reducing the risk of, disease or injury;

(c)offering to patients, where appropriate, vaccination or immunisation against measles, mumps, rubella, pertussis, poliomyelitis, diphtheria, tetanus and haemophilus influenzae type b;

(d)arranging for the referral of patients, as appropriate, for the provision of any other health services under the Order;

(e)giving advice, as appropriate, to enable patients to avail themselves of personal social services provided under the Order.

(3) A doctor is not required by sub-paragraph (1) or (2)—

(a)to provide to any person child health surveillance services, contraceptive services, minor surgery services nor, except in an emergency, maternity medical services unless he has previously undertaken to the Board to provide such services to that person; or

(b)where he is a restricted services principal, to provide any category of general medical services which he has not undertaken to provide.

(4) If a woman requires treatment immediately owing to an obstetric emergency, it shall be the duty of any doctor whose name is included in the obstetric list in whose practice area the emergency arises, who is summoned and is available or at whose surgery the woman attends and such a doctor is available, to give any treatment immediately necessary, unless a doctor who has undertaken to provide maternity medical services for her or his partner, deputy or assistant is available, and treatment under this sub-paragraph shall be given without charge unless she is not entitled to receive maternity medical services.

(5) Any charge made by a doctor in respect of treatment provided under sub-paragraph (4) shall be in accordance with any determination which may be made by the Department under regulation 37(2)(c).

(6) The treatment referred to in sub-paragraph (4) shall be given whether or not the woman is able to produce evidence of her entitlement to maternity medical services.

Provision of services to patients during and outside normal hours

14.—(1) In this paragraph, the services referred to in paragraph 13 are called the “relevant services”.

(2) Subject to the following provisions of this paragraph, a doctor shall render the relevant services during the hours for which he is normally available pursuant to paragraph 36 (in this paragraph referred to as “normal hours”)—

(a)at his practice premises; or

(b)in the case of a patient whose condition is such that, in the doctor’s reasonable opinion, it would be inappropriate for the patient to attend at the practice premises, at whichever of the places set out in sub-paragraph (5) as is appropriate.

(3) Outside normal hours, the doctor shall consider, in the light of the patient’s medical condition, whether a consultation is needed and, if so, when.

(4) If, in the doctor’s reasonable opinion, a consultation is needed before the next time at which the patient could be seen during normal hours, he shall render the relevant services—

(a)at his practice premises;

(b)at such other place as the Board has agreed, pursuant to paragraph 37, and he has informed the patient, pursuant to that paragraph, is a place where he will treat patients outside normal hours; or

(c)in the case of a patient whose condition is such that, in the doctor’s reasonable opinion, it would be inappropriate for the patient to attend either at the practice premises or at such other place, at whichever of the places set out in sub-paragraph (5) as is appropriate.

(5) The places referred to in sub-paragraphs (2)(b) and (4)(c) are—

(a)the place where the patient was residing when he was accepted by the doctor for inclusion in his list pursuant to paragraph 5 or, as the case may be, when he was assigned to the doctor pursuant to regulation 20 or, in the case of a patient who was previously on the list of a doctor in a practice declared vacant, when the doctor succeeded to the vacancy;

(b)such other place as the doctor has informed the patient and the Board is the place where he has agreed to visit and treat the patient;

(c)some other place in the doctor’s practice area.

(6) Nothing in this paragraph prevents the doctor from—

(a)arranging for the referral of a patient pursuant to paragraph 13(2)(d) without first seeing the patient, in a case where the medical condition of the patient makes that course of action appropriate; or

(b)visiting the patient in circumstances where this paragraph does not place him under an obligation to do so.

15.—(1) Subject to sub-paragraph (2), unless prevented by an emergency, a doctor shall attend and treat any patient who attends for the purpose at any place, and during the hours, for the time being approved by the Board under paragraph 36.

(2) Sub-paragraph (1) shall not apply to a patient who attends when an appointment system is in operation and who has not previously made, and is not then given, an appointment to see the doctor.

(3) A doctor may refuse to attend and treat the patient to whom sub-paragraph (2) applies, provided that—

(a)the patient’s health would not thereby be jeopardised; and

(b)the patient is offered an appointment to attend again within a time which is reasonable having regard to all the circumstances.

(4) A doctor shall take reasonable steps to ensure that no refusal is made pursuant to sub-paragraph (3) without his knowledge.

Newly registered patients

16.—(1) Subject to sub-paragraphs (4) to (10), where a patient has been accepted for inclusion in a doctor’s list under paragraph 5 or assigned to a doctor’s list under regulation 20, the doctor shall, in addition to and without prejudice to his other obligations in respect of that patient under these terms of service, within 28 days of the date of such acceptance or assignment, invite the patient to participate in a consultation either at his practice premises or, if the condition of the patient so warrants, at such other place as the doctor is obliged under paragraph 14(2)(b) to render personal medical services to that patient.

(2) Where a patient (or, in the case of a patient who is a child, his parent) agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a)seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i)illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer;

(ii)social factors (including employment, housing and family circumstances) which may affect his health;

(iii)factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol and misuse of drugs or solvents) which may affect his health; and

(iv)the current state of his health;

(b)offer to undertake a physical examination of the patient, comprising—

(i)the measurement of his blood pressure;

(ii)the taking of a urine sample and its analysis to identify the presence of albumen and glucose; and

(iii)the measurements necessary to calculate his body mass;

(c)record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d)assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient;

(e)in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient (or, where the patient is a child, his parent) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(3) On each occasion on which a doctor invites a patient to participate in a consultation mentioned in sub-paragraph (1) he shall—

(a)make the invitation in writing or, if the invitation is initially made orally, confirm it in writing by a letter either handed to the patient or his representative or sent to the patient (or, in the case of a patient who is a child, his parent) at the address recorded in his medical records as being his last known home address;

(b)record in the patient’s medical records the date of each such invitation and whether or not it was accepted; and

(c)where, as a result of making the invitation, the doctor becomes aware that the patient is no longer residing at the address shown in those medical records, advise the Agency accordingly.

(4) A doctor shall not be obliged to offer a consultation mentioned in sub-paragraph (1)—

(a)if he is a restricted services principal;

(b)in respect of a child under the age of 5 years; or

(c)to any patient who, immediately before his inclusion in his list, was a patient of a partner of the doctor and who, during the 12 months immediately preceding the date of his acceptance for inclusion in, or assignment to, the doctor’s list, had participated in a consultation mentioned in sub-paragraph (1); or

(d)to the extent allowed by the Board, to any patient within a class of patients in respect of which the Board or, on appeal, the Department has, pursuant to sub-paragraphs (5) to (9), deferred the doctor’s obligation under sub-paragraph (1).

(5) Where a doctor assumes responsibility for a list of patients on his succession to a practice declared vacant or otherwise becomes responsible for a significant number of new patients within a short period, he may apply, in accordance with sub-paragraph (6), to the Board for the deferment of his obligation under sub-paragraph (1) for a period not exceeding 2 years from the date of the application.

(6) An application pursuant to sub-paragraph (5) shall be made in writing and shall be accompanied by a statement of the doctor’s proposals, by reference to particular classes of patient, with a view to securing that all eligible patients are invited to participate in a consultation mentioned in sub-paragraph (1) by the end of the period of the deferment.

(7) Within 2 months of receiving an application pursuant to sub-paragraph (5), the Board shall determine it—

(a)by approving the application;

(b)by approving the application subject to conditions; or

(c)by refusing the application.

(8) The Board shall give notice to the doctor of its determination under sub-paragraph (7) and—

(a)where it imposes conditions pursuant to head (b) of that sub-paragraph; or

(b)refuses the application pursuant to head (c) of that sub-paragraph,

it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (9).

(9) A doctor may, within the period of 30 days beginning with and including the day on which he receives notice of the Board’s determination, appeal in writing to the Department against any refusal of an application, or against any condition subject to which an application is approved by the Board pursuant to sub-paragraph (7)(b) and, on determining such an appeal, the Department shall either confirm the Board’s determination or substitute its own determination for that of the Board.

(10) The Department shall notify the doctor in writing of its determination and shall include with the notice a statement of its reasons for the determination.

(11) In this paragraph and paragraph 17, “body mass” means the figure produced by dividing the number of kilograms in the patient’s weight by the square of the number of metres in his height.

Patients not seen within 3 years

17.—(1) Subject to sub-paragraph (2), where a patient who—

(a)has attained the age of 16 years but has not attained the age of 75 years; and

(b)within the preceding 3 years has attended neither a consultation with, nor a clinic provided by, any doctor in the course of his provision of general medical services,

requests a consultation for the purposes of assessing whether he needs personal medical services, a doctor shall, in addition to and without prejudice to any other obligation under these terms of service, provide such a consultation.

(2) Sub-paragraph (1) shall not apply in the case of a doctor who is a restricted services principal.

(3) Where a doctor provides a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a)seek details from the patient as to his medical history and, so far as may be relevant to the patient’s medical history, as to that of his consanguineous family, in respect of—

(i)illnesses, immunisations, allergies, hereditary conditions, medication and tests carried out for breast or cervical cancer;

(ii)social factors (including employment, housing and family circumstances) which may affect his health;

(iii)factors of his lifestyle (including diet, exercise, use of tobacco, consumption of alcohol and misuse of drugs or solvents) which may affect his health; and

(iv)the current state of his health;

(b)offer to undertake a physical examination of the patient, comprising—

(i)the measurement of his blood pressure;

(ii)the taking of a urine sample and its analysis to identify the presence of albumen and glucose; and

(iii)the measurements necessary to detect any changes in body mass;

(c)record, in the patient’s medical records, his findings arising out of the details supplied by, and any examination of, the patient under this sub-paragraph;

(d)assess whether and, if so, in what manner and to what extent he should render personal medical services to the patient;

(e)in so far as it would not, in the opinion of the doctor, be likely to cause serious damage to the physical or mental health of the patient to do so, offer to discuss with the patient the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

Patients aged 75 years and over

18.—(1) Subject to sub-paragraph (2), a doctor shall, in addition to and without prejudice to any other obligations under these terms of service, in each period of 12 months beginning on 1st April in each year—

(a)invite each person on his list who has attained the age of 75 years to participate in a consultation; and

(b)offer to make a domiciliary visit to each such patient,

for the purpose of assessing whether he needs to render personal medical services to that patient.

(2) Sub-paragraph (1) shall not apply in the case of any doctor who is a restricted services principal.

(3) Any consultation pursuant to sub-paragraph (1) may take place in the course of a domiciliary visit pursuant to that sub-paragraph.

(4) In the case of a patient who is accepted for inclusion in a doctor’s list pursuant to paragraph 5, or assigned to him pursuant to regulation 20, and who has attained the age of 75 years when he is so accepted or assigned, an invitation and an offer pursuant to sub-paragraph (1) shall be made within 12 months of the date of his acceptance or assignment.

(5) A doctor shall, when making an assessment following a consultation under sub-paragraph (1), record in the patient’s medical records the observations made of any matter which appear to him to be affecting the patient’s general health including, where appropriate, the patient's—

(a)sensory functions;

(b)mobility;

(c)mental condition;

(d)physical condition including continence;

(e)social environment; and

(f)use of medicines.

(6) A doctor shall keep with the patient’s medical records a report of any observations made in the course of a domiciliary visit made pursuant to sub-paragraph (1) which are relevant to the patient’s general health.

(7) When inviting a patient to participate in a consultation or offering him a domiciliary visit pursuant to sub-paragraph (1), a doctor shall comply with the requirements of paragraph 16(3) as if that paragraph referred to such an offer as well as to an invitation.

(8) Where a patient has participated in a consultation pursuant to sub-paragraph (1), the doctor shall offer to discuss with him the conclusions he has drawn, as a result of the consultation, as to the state of the patient’s health, unless to do so would, in the opinion of the doctor, be likely to cause serious harm to the physical or mental health of the patient.

Transfer of responsibility, absences, deputies, assistants and partners

19.  Subject to paragraph 20 a doctor is responsible for ensuring the provision for his patients of the services referred to in paragraph 13 throughout each day during which his name is included in the medical list.

Out of hours arrangements

20.—(1) In this paragraph and in paragraph 21—

(a)“out of hours period” means—

(i)the period beginning at 7 pm on a weekday other than a Saturday and ending at 8 am on the following day;

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

(iii)Bank and Public holidays,

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

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

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

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

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

(4) A doctor may retain responsibility for or make separate out of hours arrangements in respect of the provision of maternity medical services to patients with whom he has made an arrangement under regulation 34.

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

(6) Where a doctor’s name is included in the obstetric list, he shall not make an out of hours arrangement in respect of the provision of maternity medical services to patients with whom he has made an arrangement under regulation 34 unless the transferee doctor’s name is also included in the obstetric list.

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

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

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

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

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

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

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

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

(h)whether the proposed transferee doctor—

(i)has been notified under regulation 7(4) of the Tribunal Regulations (Northern Ireland) 1995(39) that the Tribunal intends to hold an inquiry under paragraph 1 of Schedule 11 to the Order as to representations made in relation to him; or

(ii)has been notified under section 42(5) of the Medical Act 1983(40) that the Preliminary Proceedings Committee of the General Medical Council has decided that he should be referred to the Professional Conduct Committee or to the Health Committee.

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

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

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

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

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

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

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

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

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

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

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

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

(a)the transferee doctor may himself employ or engage an assistant or deputy in respect of part or all of the period covered by the out of hours arrangement; and if he does so, paragraph 23 shall apply as if he were the doctor for the purposes of that paragraph; and

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

21.—(1) Subject to paragraph 22, where it appears to the Board that it may no longer be satisfied as to any of the matters referred to in heads (a) to (d) of paragraph 20(9), it may give notice in writing to the doctor that it proposes to review the approval.

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

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

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

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

(6) A doctor may, within the period of 30 days beginning with and including the day on which the notice referred to in sub-paragraph (4) was received by him, appeal in writing to the Department against the withdrawal of approval and sub-paragraphs (12) and (13) of paragraph 20 shall apply to any such appeal.

(7) Subject to paragraph 22(1), where the Board withdraws approval, the withdrawal shall not take effect until the end of the period of 2 months beginning with and including the date on which the notice referred to in sub-paragraph (4) was sent or where there is an appeal under sub-paragraph (6) and the appeal is dismissed, the date on which the doctor receives notice of the dismissal of the appeal, whichever is the later.

22.—(1) Where it appears to the Board, whether after a review under paragraph 21 or not, that it is necessary in the interests of the doctor’s patients to withdraw its approval immediately, it may withdraw its approval.

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

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

(4) A doctor may, within the period of 30 days beginning with and including the day on which the notice referred to in sub-paragraph (2) was received by him, appeal in writing to the Department against the withdrawal of approval and sub-paragraphs (12) and (13) of paragraph 20 shall apply to any such appeal.

23.—(1) Subject to sub-paragraphs (2) to (7), a doctor shall give treatment personally.

(2) Subject to sub-paragraphs (3), (5) and (6), and to any out of hours arrangements made under paragraph 20(2), a doctor (in this sub-paragraph referred to as “the patient’s doctor”) shall be under no obligation to give treatment personally to a patient provided that reasonable steps are taken to ensure the continuity of the patient’s treatment, and in those circumstances the treatment may be given—

(a)by another doctor acting as a deputy, whether or not he is a partner or assistant of the patient’s doctor; or

(b)in the case of treatment which it is clinically reasonable in the circumstances to delegate someone other than a doctor, by a person whom the doctor has authorised and who he is satisfied is competent to carry out such treatment.

(3) Subject to sub-paragraph (4), in the case of maternity medical services a doctor whose name is included in the obstetric list shall not arrange for the provision of such services by another doctor unless that doctor’s name is included in the obstetric list.

(4) Sub-paragraph (3) shall not apply where there has been a summons to an obstetric emergency.

(5) In the case of child health surveillance services, a doctor who has, pursuant to regulation 27, undertaken to provide such services shall not arrange for the provision of such services by—

(a)another doctor unless that doctor’s name is included in the child health surveillance list; or

(b)any other person without the consent of the Board.

(6) In the case of minor surgery services, a doctor who has, pursuant to regulation 36, undertaken to provide such services shall not arrange for the provision of such services by—

(a)another doctor unless that doctor’s name is included in the minor surgery list; or

(b)any other person.

(7) In this paragraph “a summons to an obstetric emergency” means a summons to the doctor by a midwife or by or on behalf of the patient to attend when medical attention is required urgently by a woman or her baby during pregnancy, labour or the post-natal period.

24.—(1) In relation to his obligations under these terms of service, a doctor is responsible for all acts and omissions of—

(a)any doctor acting as his deputy;

(b)any organisation providing deputy doctors as mentioned in paragraph 26 with which he has entered into an arrangement in accordance with that paragraph while acting on his behalf; and

(c)any person employed by, or acting on behalf of, him or such a deputy or such an organisation,

except where the act or omission is one for which a deputy is responsible under sub-paragraph (2) or (3).

(2) Where a doctor whose name is included in the medical list is acting as a deputy to another doctor whose name is also included in that list, the deputy alone is responsible for—

(a)his own acts and omissions in relation to the obligations under these terms of service of the doctor for whom he acts as deputy; and

(b)the acts and omissions of any person employed by him or acting on his behalf.

(3) A deputy, including a partner acting as a deputy, or an assistant whose name is included in the obstetric list shall be responsible for his own acts and omissions.

25.—(1) A doctor shall inform the Board of the arrangements for the engagement of a deputy on a regular basis unless the deputy—

(a)is an assistant of the doctor, or is a doctor whose name is included in the medical list; and

(b)is to carry out the arrangements at the doctor’s premises.

(2) Where the doctor proposes to be absent from his practice for more than 14 days, he shall inform the Board of the name of any doctor responsible for his practice during his absence.

26.—(1) In this paragraph, “organisation providing deputy doctors” means a person who provides deputies to doctors and includes a body which—

(a)consists only of doctors whose names are included in the medical list and who arrange to act as deputies to each other; and

(b)keeps separate accounts in relation to such arrangements.

(2) Before entering into arrangements with an organisation providing deputy doctors for the provision of any deputy, a doctor shall—

(a)obtain the written agreement of that organisation that any doctor it provides to him—

(i)will not be subject to a declaration under either paragraph 3(c) of Schedule 11 to the Order or under any corresponding provision in force in England and Wales or Scotland that he is not fit to be engaged in any capacity in the provision of general medical services;

(ii)will not be suspended by direction of the Tribunal, other than in a case falling within paragraph 8B(3) of Schedule 11 to the Order;

(iii)will (unless he is a trainee general practitioner acting in the place of and under the supervision of the doctor responsible for his training) be suitably experienced within the meaning of Article 8 of the Health and Personal Social Services (Northern Ireland) Order 1978 (other than by virtue of being a restricted services principal) or will have the acquired right specified in regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994(41); and

(b)take all reasonable steps to satisfy himself that the service provided by the organisation (including its monitoring arrangements) will be adequate and appropriate having regard in particular to the interests of the doctor’s patients.

(3) A doctor shall notify the Board of any arrangements he makes with an organisation providing deputy doctors.

(4) A doctor shall from time to time and at any time when there are grounds for doing so, take reasonable steps to satisfy himself that an organisation providing deputy doctors with which he has entered into arrangements for the provision of any deputy—

(a)continues to comply with the agreement referred to in sub-paragraph (2)(a); and

(b)continues to provide a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b).

(5) Subject to sub-paragraph (6), if the Board so requests, a doctor shall furnish it with evidence that such an organisation is continuing—

(a)to comply with the agreement mentioned in sub-paragraph (2)(a); or, as the case may be,

(b)to provide a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b).

(6) A Board shall not make a request for evidence under sub-paragraph (5)(b) unless—

(a)it has reasonable grounds for believing that the organisation providing deputy doctors is not providing a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b); and

(b)it has consulted the Local Medical Committee.

(7) Subject to sub-paragraph (8), where in response to a request for evidence under sub-paragraph (5)(b) the Board continues to have reasonable grounds for believing that the organisation providing deputy doctors is not providing a service which is adequate and appropriate as mentioned in sub-paragraph (2)(b), it shall give notice (in this paragraph referred to as a “remedial notice”) to the doctor specifying—

(a)the grounds for its concern;

(b)the remedial action which it considers necessary; and

(c)the date before which such action must be taken.

(8) A Board shall not issue a remedial notice under sub-paragraph (7) without first consulting the Local Medical Committee.

(9) Where a Board issues a remedial notice under sub-paragraph (7), it shall also send a copy of that notice to any other doctor who has made arrangements with the organisation providing deputy doctors.

(10) Where it appears to the Board—

(a)that an organisation providing deputy doctors with which a doctor has made arrangements for the provision of a deputy—

(i)is not complying with the agreement referred to in sub-paragraph (2)(a); or

(ii)has not taken the action specified in a remedial notice issued under sub-paragraph (7) within the time specified in that notice; or

(b)that a doctor’s arrangement with such an organisation is such that the doctor’s patients are at risk,

it may give notice to the doctor requiring him to bring his arrangement with that organisation to an end either immediately or before such date as is stated in the notice.

27.  A doctor shall not engage another doctor as a deputy, or employ one as an assistant, unless the other doctor—

(a)is suitably experienced within the meaning of Article 8 of the Health and Personal Social Services (Northern Ireland) Order 1978 (other than by virtue of being a restricted services principal); or

(b)has the acquired right specified in regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations 1994; or

(c)is a trainee general practitioner acting in the place of and under the supervision of the doctor responsible for his training.

28.  A doctor shall not engage as a deputy or employ as an assistant any doctor—

(a)who, having been disqualified under paragraph 3(b) of Schedule 11 to the Order (or under any corresponding provision in operation in England and Wales or Scotland) from inclusion of his name in the medical list (or, in England and Wales, the medical list of a Health Authority or, in Scotland, the medical list of a Health Board), is also the subject of a declaration under paragraph 3(c) of Schedule 11 to the Order (or any corresponding provision in operation in England and Wales or Scotland) that he is not fit to be engaged in any capacity in the provision of general medical services; or

(b)who is suspended by direction of the Tribunal, other than in a case falling within paragraph 8B(3) of Schedule 11 to the Order.

29.—(1) A doctor shall—

(a)inform the Board of the name of any assistant he employs and of the termination of such employment;

(b)on request, furnish on a form supplied by the Board any information in connection with the employment notified to the Board in head (a) which may be required by the Agency for the purposes of the Health and Personal Social Services (Superannuation) Regulations (Northern Ireland) 1995(42);

(c)not employ any one or more assistants for a total period of more than 3 months in any period of 12 months without the consent of the Board.

(2) The Board shall periodically review and may withdraw any consent given but, before refusing or withdrawing consent, the Board shall consult the Local Medical Committee and shall notify the doctor of any refusal or withdrawal of consent.

(3) The doctor may, within the period of 30 days beginning with and including the day on which he receives notification of the Board’s determination, appeal to the Department against any refusal or withdrawal of consent.

(4) Any withdrawal of consent under this paragraph shall not have any effect until the expiration of a period of one month after the date of notification of the withdrawal, but if the doctor appeals to the Department against the withdrawal and the Department dismisses the appeal, the withdrawal shall not take effect until after such date as the Department determines being a date falling not less than one month after the date of the dismissal of the appeal.

30.—(1) A doctor acting as a deputy shall be entitled to treat patients at places and at times other than those arranged by the doctor for whom he is acting, due regard being had to the convenience of the patients.

(2) A doctor acting as a deputy for another doctor may not treat the other doctor’s patients at any place approved under paragraph 36 unless it is so approved for the availability of that other doctor.

31.  When issuing any document under these terms of service, a deputy or assistant (other than a partner or assistant whose name is included in the medical list) shall, as well as signing the document himself, enter on it the name of the doctor for whom he is acting, if it does not already appear.

Practice Premises

32.  A doctor shall not, except with the approval of the Board, provide general medical services in premises occupied by a chemist.

Arrangements at practice premises

33.  A doctor shall—

(a)provide proper and sufficient accommodation—

(i)at his practice premises, having regard to the circumstances of his practice; and

(ii)at any other premises at which the Board, in accordance with paragraph 36, has agreed he may treat his patients; and

(b)on receipt of a written request from the Board, allow inspection of those premises at a reasonable time by a member or officer of the Board or Local Medical Committee or both, authorised by the Board for the purpose.

34.  A doctor who—

(a)intends to operate an appointments system;

(b)succeeds to a practice where such a system is in operation; or

(c)joins a partnership operating such a system,

shall notify the Board of any appointments system which he proposes to operate or, as the case may be, of any proposal to discontinue such a system.

Employees

35.—(1) A doctor shall, before employing any person to assist him in the provision of general medical services, take reasonable care to satisfy himself that the person in question is both suitably qualified and competent to discharge the duties for which he is to be employed.

(2) The duty imposed by paragraph (1) is in addition to the duty imposed by paragraph 27(a) so far as it relates to assistants.

(3) When considering the competence and suitability of any person for the purpose of sub-paragraph (1), a doctor shall have regard, in particular, to—

(a)that person’s academic and vocational qualifications;

(b)that person’s training and his experience in employment; and

(c)any guidance issued by the Board pursuant to regulation 43.

(4) A doctor shall afford to each employee reasonable opportunities to undertake appropriate training with a view to maintaining that employee’s competence.

Doctors' availability to patients

36.—(1) Any doctor whose name is included in the medical list shall—

(a)be available normally at such times and places as, following an application by the doctor, the Board shall approve after consultation with the Local Medical Committee, or, on appeal the Department, shall determine in his case, in accordance with the requirements of the following provisions of this paragraph; and

(b)inform his patients about his availability in such manner as the Board may require in accordance with sub-paragraph (16).

(2) Subject to sub-paragraphs (3), (4), (5) and (6), the Board shall not approve any application submitted to it by a doctor in relation to the times at which he is to be available unless it is satisfied that—

(a)the times proposed are such that the doctor will normally be available—

(i)in 42 weeks in any period of 12 months;

(ii)for no less than the number of hours in any such week which are specified in relation to him under regulation 13; and

(iii)on 5 days in any such week;

(b)the hours for which the doctor will normally be available in any week shall be allocated between the days on which he will normally be available in that week in a manner likely to be convenient to his patients;

(c)where the doctor is a three-quarter-time doctor or a half-time doctor, he is practising in partnership with—

(i)another doctor whose name is included in the medical list and who is himself a full-time doctor; or

(ii)2 job-sharing doctors whose names are included in the medical list and whose hours are aggregated for the purposes of head (d);

(d)where the doctor is a job-sharing doctor—

(i)he is practising in partnership with another doctor whose name is included in the medical list; and

(ii)the hours for which both doctors will normally be available will, in aggregate, be not less than 26 hours in any week referred to in head (a)(i).

(3) On any application made pursuant to sub-paragraph (1) by a three-quarter-time doctor or a half-time doctor—

(a)head (a)(iii) of sub-paragraph (2) shall not apply; and

(b)any approval of the application shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which that doctor ceases to satisfy sub-paragraph (2)(c).

(4) On any application made pursuant to sub-paragraph (1) by a job-sharing doctor—

(a)head (a)(iii) of sub-paragraph (2) shall apply so as to require either the job-sharing doctor or the other doctor referred to in sub-paragraph (2)(d) to be normally available on each of the days mentioned in that head; and

(b)any approval of the application shall be subject to the condition that the approval shall lapse after the expiry of a period of 6 months from the date on which the doctor ceases to satisfy sub-paragraph (2)(d).

(5) On any application made pursuant to sub-paragraph (1) by a doctor who is a restricted list principal or a restricted services principal, sub-paragraph (2)(a)(i) and (iii), (c) and (d) shall not apply.

(6) The Board may, in relation to the application of any full-time doctor who seeks normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a)(i), excuse the doctor from the requirement of head (a)(iii) of that sub-paragraph and approve the application to the extent allowed by paragraph 38.

(7) In this paragraph and in paragraph 38, “available” means, in relation to a doctor, available to provide general medical services to his patients, and for the purposes of calculating the time at which a doctor is regarded as available—

(a)account may be taken of any period when the doctor is attending at his practice premises or at any clinic provided by him for his own patients, and of any time spent making a domiciliary visit; but

(b)no account shall be taken of time spent by the doctor holding himself in readiness to make a domiciliary visit if required by any patient.

(8) An application by a doctor in relation to any place at which he is available shall not be approved by the Board unless it is satisfied that the place at which the doctor proposes to be available is likely to be convenient to his patients.

(9) An application for approval pursuant to sub-paragraph (1) shall be made in writing to the Board and shall—

(a)include the information specified in Part I of Schedule 8; and

(b)where appropriate, also include—

(i)in the case of a doctor to whom sub-paragraph (5) applies, the additional information specified in Part II of that Schedule;

(ii)in the case of a doctor to whom sub-paragraph (6) applies, the additional information specified in Part III of that Schedule.

(10) The Board shall determine an application within 28 days of receiving it.

(11) In determining any application, the Board shall either—

(a)grant approval;

(b)grant approval subject to such conditions as the Board sees fit to impose for the purpose of securing that the doctor is available at such times and places as are convenient to his patients; or

(c)refuse approval.

(12) Τhe Board shall notify the doctor in writing of its determination, and, where it refuses an application or grants an application subject to conditions, it shall send the doctor a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (13).

(13) A doctor may, within the period of 30 days beginning with and including the day on which the statement referred to in sub-paragraph (12) was received by him, appeal in writing to the Department against any refusal of approval or against any condition imposed pursuant to sub-paragraph (11).

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

(15) The Department shall notify the doctor in writing of its determination and shall in every case include with the notification a written statement of the reasons for the determination.

(16) The Board may require a doctor to inform his patients, by displaying a notice at his practice premises or by sending notices to them, about the times and places at which he is available.

(17) A doctor may apply to the Board for a variation of the times and places at which, in accordance with a determination under this paragraph (“the earlier determination”), he is required to be normally available, and sub-paragraphs (2) to (15) shall apply to the making and determination (“the subsequent determination”) of an application under this sub-paragraph as if it were the first application by that doctor for the purposes of this paragraph.

(18) Where an application made under sub-paragraph (17) is granted or is granted subject to conditions, for the purposes of sub-paragraphs (1) and (16) the earlier determination mentioned in sub-paragraph (17) shall cease to have effect and the subsequent determination mentioned in that sub-paragraph shall have effect instead—

(a)where the subsequent determination is made by the Board and no appeal is made, from the day falling 8 weeks after the date on which the doctor receives notification of the Board’s determination;

(b)where the subsequent determination is made on appeal, from the day falling 8 weeks after the date on which the doctor receives notice of the determination of the appeal by the Department.

(19) Where it appears to the Board that a doctor’s hours of availability are allocated for the purposes of sub-paragraph (2)(b) in a manner which may no longer be convenient to his patients, it may, subject to sub-paragraph (26), review the terms of—

(a)any approval granted under sub-paragraph (11)(a) or (b); or

(b)any direction given under sub-paragraph (21)(a).

(20) On any review under sub-paragraph (19) the Board shall—

(a)give notice to the doctor of its proposed reallocation of his hours or availability; and

(b)allow him 30 days, beginning with and including the day on which he receives that notice, within which to make representations to the Board about its proposals.

(21) After considering any representations made in accordance with sub-paragraph (20)(b), the Board shall either—

(a)direct the doctor to revise the allocation of his hours of availability in the manner specified in the direction; or

(b)confirm that the existing allocation of the doctor’s hours of availability continues to be convenient to his patients.

(22) The Board shall notify the doctor in writing of its determination under sub-paragraph (21) and, where it gives a direction under head (a) of that sub-paragraph, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (23).

(23) A doctor may, within the period of 30 days beginning with and including the day on which the notice under sub-paragraph (22) was received by him, appeal in writing to the Department against a direction under sub-paragraph (21).

(24) Sub-paragraphs (14) and (15) shall apply to any appeal made under sub-paragraph (23).

(25) A doctor in respect of whom a direction is given under sub-paragraph (21)(a) shall revise the allocation of his hours of availability so as to give effect to the direction—

(a)where the direction is given by the Board and no appeal is made, not less than 8 weeks after the date on which he receives notification under sub-paragraph (22); or

(b)where the direction is given or confirmed on appeal, not later than 8 weeks after the date on which he receives notification of the determination of the appeal by the Department,

and the allocation of hours as so revised shall be regarded as having been approved for the purposes of sub-paragraphs (1) and (16).

(26) A Board shall not undertake a review under sub-paragraph (19) on more than one occasion in any period of 2 years.

Availability to patients outside normal hours

37.—(1) Subject to the provisions of this paragraph, a doctor may apply to the Board for approval to treat patients at premises other than his practice premises outside the hours for which he is normally available pursuant to paragraph 36 (in this paragraph referred to as “normal hours”).

(2) An application under sub-paragraph (1) shall be made in writing and shall state the address of the premises in respect of which the application is made.

(3) An application under sub-paragraph (1) shall not be approved by the Board unless it is satisfied that, having regard to—

(i)the fact that the premises are for the treatment of patients outside normal hours; and

(ii)all other relevant circumstances,

the premises to which the application relates are likely to be reasonably convenient to the doctor’s patients.

(4) Sub-paragraphs (10) to (15) of paragraph 36 shall apply to an application under sub-paragraph (1) as they apply to an application under paragraph 36(1).

(5) Where the Board determines an application under sub-paragraph (1) by granting approval (with or without conditions), the doctor shall inform his patients by displaying a notice at his practice premises, stating the address of the premises for which approval has been granted.

(6) A doctor may apply to the Board for a variation of any approval granted under this paragraph, and such application shall be made and determined as if it were the first application for the purposes of this paragraph.

(7) Where it appears to the Board that premises which it has approved under this paragraph may no longer be reasonably convenient to the doctor’s patients, it may give notice to the doctor that it proposes to review the terms of the approval.

(8) On any review under sub-paragraph (7), the Board shall allow the doctor a period of 30 days, beginning with and including the date on which he receives the notice, within which to make representations to the Board about its proposals.

(9) After considering any representations made in accordance with sub-paragraph (8), the Board may determine to—

(a)continue its approval;

(b)continue its approval subject to such new or varied conditions as it sees fit to impose; or

(c)withdraw its approval.

(10) The Board shall notify the doctor in writing of its determination under sub-paragraph (9); and where it determines to withdraw its approval or to continue it subject to new or varied conditions, it shall include with the notice a statement in writing of the reasons for its determination and of the doctor’s right of appeal under sub-paragraph (11).

(11) A doctor may, within the period of 30 days beginning with and including the date on which he receives the notice referred to in sub-paragraph (10), appeal in writing to the Department against the withdrawal of approval or against any condition imposed pursuant to sub-paragraph (9); and sub-paragraphs (14) and (15) of paragraph 36 shall apply to any such appeal as they apply to an appeal under that paragraph.

Doctors available for only 4 days a week

38.—(1) Subject to sub-paragraph (3), where the Board is satisfied that, by reason of a doctor’s participation in health-related activities (other than the provision of general medical services to his patients), he would be likely to suffer an unreasonable degree of inconvenience if paragraph 36(2)(a)(iii) applied in his case, it may give its approval for the doctor normally to be available on only 4 days in any week referred to in sub-paragraph (2)(a) of that paragraph.

(2) For the purposes of sub-paragraph (1), “health-related activities” means activities connected with—

(a)the organisation of the medical profession or the training of its members;

(b)the provision of medical care or treatment;

(c)the improvement of the quality of such care and treatment; or

(d)the administration of services under Part II of the Order or of arrangements pursuant to Article 56 of the Order(43) for the provision of general medical services,

and, in determining whether any activity is a health-related activity, the Board shall have regard to the illustrative list in Part IV of Schedule 8.

(3) The Board shall not give its approval in accordance with sub-paragraph (1) if, in its opinion—

(a)the effectiveness of the doctor’s services to his patients is likely to be significantly reduced; or

(b)his patients are likely to suffer significant inconvenience,

by reason of the doctor having been relieved from the requirements of paragraph 36(2)(a)(iii).

Practice area

39.—(1) Subject to sub-paragraph (3), a doctor may at any time with the consent of the Board alter the extent of his practice area.

(2) Where the Board refuses consent to the alteration of a practice area it shall notify the doctor in writing of such refusal and the doctor may, within the period of 30 days beginning with and including the day on which he receives such notification, appeal to the Department.

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

(4) The Department shall notify the doctor in writing of its determination and shall in every case include with the notification a statement of the reasons for the determination.

(5) A doctor shall not open practice premises in any area or part of an area where, at the time of his application to open such premises, the Board is of the opinion that the number of medical practitioners undertaking to provide general medical services in that area or part of that area is already adequate.

Notification of change of place of residence

40.  Where a doctor whose name is included in the medical list changes his place of residence, he shall notify the Board in writing of the change not later than 28 days after such change.

Records

41.  A doctor shall—

(a)keep adequate records of the illnesses and treatment of his patients on forms supplied to him for the purpose by the Agency;

(b)permit a medical officer of the relevant Board to inspect medical records of patients and to provide him with any necessary information with regard to the entries therein as he may request for the purposes of ascertaining whether or not such records are properly kept;

(c)forward such records to the Agency or the relevant Board on request as soon as possible; and

(d)upon the termination in accordance with regulation 34(6) or (7) of arrangements between him and a woman for the provision of maternity medical services, forward to the relevant Board the medical records of the patient concerned; and

(e)within 14 days of being informed by the Agency of the death of a person on his list and, in any other case of the death of such a person, not later than one month of learning of such a death, forward the records relating to that person to the Agency.

Certification

42.—(1) A doctor shall issue free of charge to a patient or his personal representatives, any medical certificate of a description mentioned in column 1 of Schedule 9, which is reasonably required under or for the purposes of the statutory provisions specified in column 2 of that Schedule, except where, for the condition to which the certificate relates, the patient—

(a)is being attended by another doctor (other than a partner, assistant or other deputy of the first named doctor); or

(b)is not being treated by, or under the supervision of, a doctor.

(2) The exception in sub-paragraph (1)(a) shall not apply where the certificate is issued pursuant to regulation 2(1) of the Social Security (Medical Evidence) Regulations (Northern Ireland) 1976(44) (which provides for the issue of a certificate in the form of a special statement by a doctor on the basis of a written report by another doctor).

(3) Any certificate under sub-paragraph (1) for the purposes of the Social Security Contributions and Benefits (Northern Ireland) Act 1992(45) or the Social Security Administration (Northern Ireland) Act 1992(46) shall be issued in accordance with any Regulations made under either of those Acts.

Fees

43.  A doctor shall not, otherwise than under or by virtue of these Regulations, demand or accept a fee or other remuneration for any treatment, including child health surveillance services, contraceptive services, maternity medical services and minor surgery services, whether under these terms of service or not, which he gives to a person for whose treatment he is responsible under paragraph 3, except—

(a)from any statutory body for services rendered for the purpose of that body’s statutory functions;

(b)from any body, employer or school for a routine medical examination of persons for whose welfare the body, employer or school is responsible, or an examination of such persons for the purpose of advising the body, employer or school of any administrative action it might take;

(c)for treatment which is not of a type usually provided by general practitioners and which is given—

(i)in accommodation made available for private patients in accordance with Article 31 of the Order(47); or

(ii)in a registered nursing home which is not providing services under the Order,

if, in either case, the doctor is serving on the staff of a hospital providing services under the Order as a specialist providing treatment of the kind the patient requires and if, within 7 days of giving the treatment, the doctor supplies the Agency, on a form provided by it for the purpose, with such information about the treatment as it may require;

(d)from a dentist for the administration of an anaesthetic required for the purposes of dental treatment;

(e)when he treats a patient under paragraph 3(3), in which case he shall be entitled to demand and accept a reasonable fee (recoverable in certain circumstances under paragraph 44) for any treatment given, if he gives the patient a receipt on a form supplied by the Agency;

(f)for attending and examining (but not otherwise treating) a patient at his request at a police station in connection with proceedings that the police are minded to bring against that patient;

(g)for treatment consisting of an immunisation for which no remuneration is payable by the Agency in pursuance of the Statement made under regulation 37 and which is requested in connection with travel abroad;

(h)for circumcising a patient for whom such an operation is requested on religious grounds and is not needed on any medical ground;

(i)for prescribing or providing drugs which a patient requires to have in his possession solely in anticipation of the onset of an ailment while he is outside the United Kingdom but for which he is not requiring treatment when the medicine is prescribed;

(j)for a medical examination, under Article 23(2)(c) of the Road Traffic (Seat Belts) (Northern Ireland) Order 1995(48), to enable a decision to be made whether or not it is inadvisable on medical grounds for a person to wear a seat belt;

(k)where the person is not one to whom any of sub-paragraphs (a), (b) or (c) of Article 62(1)(49) of the Order applies (including by reason of Regulations under Article 62(6)(50)), for testing the sight of that person;

(l)where he is a doctor who is required by a Board under regulation 12 of the Pharmaceutical Regulations to provide drugs, medicines or appliances to a patient and provides for that patient, otherwise than under pharmaceutical services, any Scheduled drug;

(m)pursuant to an arrangement with him for the provision of services in accordance with regulation 20 of the Health and Personal Social Services (Fund-holding Practices) Regulations (Northern Ireland) 1993(51);

(n)for prescribing or providing drugs for malaria chemoprophylaxis;

(o)from a partner or assistant in respect of the provision of an anaesthetic to a patient of the partner or assistant.

44.—(1) Where a person from whom a doctor received a fee under paragraph 43(e) applies to the Agency for a refund within 14 days of payment of the fee (or such longer period, not exceeding one month, as the Agency may allow if it is satisfied that the failure to apply within 14 days was reasonable) and the Agency is satisfied that the person was on the doctor’s list when the treatment was given, the Agency may recover the amount of the fee from the doctor, by deduction from his remuneration or otherwise, and shall pay that amount to the person who paid the fee.

(2) Where a doctor has supplied any drug or appliance in respect of which, in the case of a person on his list, he would have been entitled to payment, the Agency shall credit him with the appropriate amount.

45.  Subject to sub-paragraphs (f), (j) and (o) of paragraph 43, a doctor shall not demand or accept a fee or other remuneration from a patient of his for any prescription for any drug or appliance.

46.  A doctor shall not, without reasonable excuse, demand or accept from a Board or the Agency any fee or other remuneration to which he is not entitled under these Regulations, the Statement published under regulation 37 or the Drug Tariff.

47.  A doctor shall take all practicable steps to ensure that any partner, deputy or assistant of his, whether or not the partner, deputy or assistant is providing general medical services, shall not demand or accept any fee or other remuneration for treatment given to the doctor’s patients, or for any prescription for any supply of any drug or appliance for the doctor’s patients, unless the partner, deputy or assistant would have been entitled to demand or accept such fee or other remuneration if the patient had been on his own list.

Prescribing

48.—(1) Subject to paragraph 49, a doctor shall order any drugs or appliances which are needed for the treatment of any patient to whom he is providing treatment under these terms of service by issuing to that patient a prescription form, and such a form shall not be used in any other circumstances.

(2) In issuing any prescription form under paragraph (1) the doctor shall himself sign the form in ink with his initials, or forenames, and surname in his own handwriting and not by means of a stamp, and shall so sign only after particulars of the order have been inserted in the form, and—

(a)the prescription shall not refer to any previous prescription; and

(b)a separate prescription form shall be used for each patient, except where a special arrangement has been made in accordance with regulation 5 of the Pharmaceutical Regulations.

(3) Where a doctor orders drugs specified in Schedule 2 to the Misuse of Drugs Regulations (Northern Ireland) 1986(52) (controlled drugs to which regulations 14, 15, 16, 18, 19, 20, 21, 23, 25 and 26 of those Regulations apply) for supply by instalments for treating addiction to any drug specified in that Schedule, he shall—

(a)use only the prescription form provided by the Agency specially for the purposes of supply by instalments;

(b)specify the number of instalments to be dispensed and the interval between each instalment; and

(c)order only such quantity of the drug as will provide treatment for a period not exceeding 14 days.

(4) The form referred to in head (a) of sub-paragraph (3) shall not be used for any purpose other than ordering drugs in accordance with that sub-paragraph.

(5) In a case of urgency, a doctor may request a chemist to dispense a drug or an appliance before a prescription form is issued, only if—

(a)that drug is not a Scheduled drug;

(b)that drug is not a controlled drug within the meaning of the Misuse of Drugs Act 1971(53) other than a drug which is for the time being specified in Schedule 5 to the Misuse of Drugs Regulations (Northern Ireland) 1986; and

(c)the doctor undertakes to furnish the chemist, within 72 hours, with a prescription form completed in accordance with sub-paragraph (2).

49.—(1) In the course of treating a patient to whom he is providing treatment under these terms of service, a doctor shall not order on a prescription form a drug or other substance specified in Schedule 10 but may otherwise prescribe such a drug or other substance for that patient in the course of treatment.

(2) In the course of treating such a patient a doctor shall not order on a prescription form a drug specified in an entry in column 1 of Schedule 11 unless—

(a)that patient is a person of a description mentioned in column 2 of that Schedule opposite that entry;

(b)that drug is prescribed for that patient only for the purpose specified in column 3 of that Schedule opposite that entry; and

(c)the doctor endorses the face of the form with the reference “S.11”,

but may otherwise prescribe such a drug for that patient in the course of that treatment.

50.  For the purposes of paragraphs 48 and 49 in their application to a doctor who has undertaken to provide contraceptive services, “drugs” includes contraceptive substances and “appliances” includes contraceptive appliances.

Practice leaflet

51.—(1) Subject to paragraph (2), a doctor whose name is included in the medical list shall compile, in relation to his practice, a document (in this paragraph called a “practice leaflet”) which shall include the information specified in Schedule 12.

(2) Sub-paragraph (1) shall, in relation to a restricted doctor, apply only to the extent that the Board sees fit.

(3) A doctor shall review his practice leaflet at least once in every period of 12 months, and shall make any amendments necessary to maintain its accuracy.

(4) A doctor shall make available a copy of the most recent edition of his practice leaflet to the Board, the Agency, to each patient on his list and to any other person who, in the doctor’s opinion, reasonably requires one.

(5) A doctor who practises in partnership with other doctors whose names are included in the medical list, shall satisfy the requirements of this paragraph if he makes available a practice leaflet, compiled in accordance with sub-paragraph (1) and, where appropriate, amended in accordance with sub-paragraph (3), which relates to the partnership as a whole; and in such a case a doctor may, if he so wishes, also produce a practice leaflet relating to his own activities.

Complaints

52.—(1) Subject to sub-paragraph (2), a doctor shall establish, and operate in accordance with this paragraph, a procedure (in this paragraph and in paragraph 53 referred to as a “practice based complaints procedure”) to deal with any complaints made by or on behalf of his patients and former patients.

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

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

(a)the doctor;

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

(c)a former partner of the doctor;

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

and in this paragraph and paragraph 53, references to complaints are to complaints falling within this sub-paragraph.

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

(a)where the patient is a child—

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

(ii)where the child is in the care of an authority to whose care he has been committed under the provisions of the Children (Northern Ireland) Order 1995(54), by a person duly authorised by that authority; or

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

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

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

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

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

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

(b)all complaints shall be—

(i)recorded in writing;

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

(iii)properly investigated;

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

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

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

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

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

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

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

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

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

Reports to medical officer of the Department

54.  A doctor shall—

(a)supply in writing to a medical officer of the Department within such reasonable period as that officer may specify, any relevant clinical information which he requests about a patient to whom the doctor under these terms of service has issued or has refused to issue a medical certificate;

(b)answer any inquiries by a medical officer of the Department about a medical certificate issued by the doctor under these terms of service or about any statement which the doctor has made in a report under these terms of service.

Inquiries about prescriptions and referrals

55.—(1) A doctor whose name is included in the medical list shall, subject to sub-paragraphs (2) and (3), sufficiently answer any inquiries, whether oral or in writing, from the Board concerning—

(a)any prescription form issued by the doctor under these terms of service;

(b)the considerations by reference to which the doctor issues such forms under these terms of service;

(c)the referral by the doctor under these terms of service of any patient to any other services provided under the Order; and

(d)the considerations by reference to which the doctor refers patients to any such services.

(2) An inquiry referred to in sub-paragraph (1) may be made only for the purpose either of obtaining information to assist the Board to discharge its functions or of assisting the doctor in the discharge of his obligations under these terms of service.

(3) A doctor shall not be obliged to answer any inquiry referred to in sub-paragraph (1) unless it is made by a doctor appointed under regulation 42 who produces, on request, written evidence that he is authorised by the Board to make such an inquiry on behalf of the Board.

Annual reports

56.—(1) A doctor whose name is included in the medical list shall provide annually to the Board a report, in accordance with this paragraph, relating to the provision by him of personal medical services (in this paragraph called an “annual report”).

(2) An annual report shall contain—

(a)the information specified in paragraphs 1 and 2 of Schedule 13;

(b)where the Board, having considered whether the information is available to it from another source and having consulted the Local Medical Committee, so requests, the information specified in paragraph 3 of Schedule 13; and

(c)where the Board so requests, in the case of a doctor who is not already supplying that information to the Board in order to qualify for payments in respect of disease management, the information specified in paragraph 4 of Schedule 13.

(3) Each annual report shall be compiled in respect of the period of 12 months ending on the 31st March of the year in which it is provided and shall be sent to the Board by 30th June of that year.

(4) In the case of a doctor who practises in partnership with other doctors whose names are included in the medical list, the information referred to in sub-paragraph (2) may alternatively be provided in the form of an annual report in respect of the partnership as a whole instead of by each doctor in the partnership individually and in such a case a doctor may, if he so wishes, also produce his own annual report.

(5) Where the Board requires that the information referred to in sub-paragraph (2) be provided on a form supplied by the Board, the doctor shall use that form.

(6) The Board shall not disclose any annual report to any person, unless otherwise lawfully empowered to do so.

Incorporation of provisions of regulations etc.

57.—(1) Any provision of the following affecting the rights and obligations of doctors shall be deemed to form part of the terms of service—

(a)the Order;

(b)these Regulations;

(c)the Charges for Drugs and Appliances Regulations (Northern Ireland) 1997(55);

(d)the Disciplinary Procedures Regulations insofar as they relate to—

(i)the investigation of questions arising between doctors and their patients and other investigations to be made by the Disciplinary Committee and the action which may be taken by the Board as a result of such investigations;

(ii)appeals to the Department from decisions of the Board or the Agency;

(iii)the investigation of cases of alleged excessive prescribing;

(iv)the investigation of certification;

(v)the investigation of record keeping;

(vi)decisions as to treatment for which fees may be charged.

(2) Where in accordance with regulation 31(3) any restrictions have been imposed with regard to the inclusion of a doctor’s name on the obstetric list, such restrictions shall be deemed to form part of his terms of service.

Regulation 8(1)

SCHEDULE 3

Part IInformation to be provided by a board to the medical committee in relation to the filling or dispersal of a medical practice vacancy on the death, withdrawal or removal of a doctor from the medical list

1.  The full name, age, practice address and sex of the doctor and date of his death, withdrawal or removal from the medical list.

2.  Whether or not the doctor was required under regulation 12 of the Pharmaceutical Regulations to provide drugs or appliances.

3.  In respect of a single-handed doctor, whether the practice premises are for sale or rent.

4.  The full name, age, practice address or addresses and sex of each doctor who provides general medical services from practice premises situated up to 5 miles from the doctor’s practice premises.

5.  An account of any report from the Local Medical Committee.

6.  Any other information that the Board considers to be relevant.

Regulations 9(1), 10(1) and 11(1)

Part IIAInformation and undertakings to be included in any application to practise

1.  Full name.

2.  Sex.

3.  Date of birth.

4.  Private address and telephone number.

5.  Whether or not his name is included in the medical list and, if so, cypher number.

6.  Whether the application is in respect of a new practice or an extension of the doctor’s current practice.

7.  Notification of address or addresses of proposed practice premises.

8.  Notification of the geographical boundary of the proposed practice area by reference to a sketch, diagram or plan.

9.  Undertaking that, if accepting as a patient a person who, at the time of acceptance or succession, is residing at a place outside the practice area, he will visit him at that address.

10.  Proposed place of residence (including telephone number and distance from main practice premises) and an undertaking to inform the Board whenever changing permanent residence.

11.  Telephone number at which prepared to receive messages.

12.  Name and private address of—

(a)any intended partnership and whether or not the names of the partners are included in the medical list; and

(b)members of group (other than those already specified in sub-paragraph (a)) with whom doctor intends to practise.

13.  Whether the applicant intends to practise as—

(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.

14.  Where the applicant intends to practise as a job-sharing doctor, the name of the other job-sharing doctor with whose hours the applicant’s hours are to be aggregated for the purposes of regulation 13(d).

15.  Notification of the proposed days and hours of attendance.

16.  In the case of an application by a doctor for the inclusion of his name in the medical list as a restricted list principal, the name of the establishment or organisation, with which patients are connected, to whom the applicant will be limiting the provision of general medical services, and the number of such patients.

Regulation 9(1)

Part IIBAdditional information to be provided by a doctor in connection with an application to fill a vacancy

1.  Whether applying to succeed to a practice, or be appointed to a vacancy in a practice.

2.  Professional experience (including starting and finishing dates to each appointment) separated into:

(a)trainee or assistant experience in general practice;

(b)general practice experience;

(c)hospital appointments;

(d)other (including obstetric) experience;

(e)any additional supporting particulars.

3.  The name and address of each doctor whose name is included in the medical list by whom the applicant has been employed as a trainee or assistant.

4.  Particulars of covenants restricting medical practice by the applicant in the Board’s area.

5.  Names and addresses of two referees.

Regulations 9(1), 10(1) and 11(1)

Part IICAdditional evidence, information and undertakings to be provided by a doctor whose name is not already on the medical list

1.  Medical qualifications, where obtained and evidence that the applicant is suitably qualified within the meaning of the Medical Practitioners (Vocational Training) Regulations (Northern Ireland) 1979(56).

2.  Declaration that he is a registered medical practitioner, included in the Medical Register in that name.

3.  Registration number in the Medical Register and date of first registration.

4.  Present or most recent appointment and, if in general practice, whether as a principal, assistant or locum.

5.  Particulars of any outstanding application for inclusion in the medical list.

6.  Whether or not applied/intending to apply for inclusion in—

(a)the obstetric list;

(b)the minor surgery list; or

(c)the child health surveillance list.

7.  Information about general medical services to be provided and, in particular, whether they will—

(a)include

exclude

be limited to

}maternity medical services

(b)include

exclude

be limited to

}contraceptive services—

(i)excluding

including

}the fitting of intra-uterine devices

(ii)restricted

not restricted

}to patients to whom the doctor or partner provides other personal medical services

(c)include

exclude

be limited to

}child health surveillance services

(d)include

exclude

be limited to

}minor surgery services

8.  Undertaking to be bound by the terms of service.

Regulation 10(1)

Part IIIInformation and undertakings to be provided by the existing partners in relation to an application to practise in partnership

1.  Reason for application (whether an additional partner or replacement or job-sharing arrangement).

2.  Particulars of each existing partner who will form part of proposed new partnership, including—

(a)name and cypher number;

(b)whether practising as—

(i)a full-time doctor;

(ii)a three-quarter-time doctor;

(iii)a half-time doctor; or

(iv)a job-sharing doctor;

(c)age;

(d)number of persons on list;

(e)proposed partnership shares, dates and exclusions (if any)—

(i)commencing;

(ii)first share change;

(iii)second share change; and

(iv)third share change;

(f)time spent on other health service appointments or health service administration, including—

(i)number of sessions;

(ii)type of appointment; and

(iii)average weekly hours; and

(g)time spent on regular non-health service appointments (eg Medical Referee, Police Surgeon, Occupational Medicine etc), including—

(i)type of appointment; and

(ii)average weekly hours.

3.  Whether or not income from—

(a)other health service appointments; or

(b)non-health service appointments,

is pooled and shared according to partnership shares.

4.  Declaration that each member of the proposed partnership shall discharge the duties and exercise the powers of a principal in connection with the practice of the partnership.

5.  Declaration that none of the partners shall either jointly or separately be engaged in the buying or selling of the goodwill or any part of the goodwill of a medical practice, prohibited by Article 60 of and Schedule 10 to the Order, whether or not provided for in the Agreement mentioned in paragraph 6.

6.  Undertaking to enter into an Agreement in writing embodying all the relevant conditions under which the partnership subsists and including provisions under which the partnership may be dissolved.

7.  Undertaking to forward a copy of the Agreement mentioned in paragraph 6 to the Agency within a reasonable period of the commencement date of the Agreement.

Regulation 14(2)

Part IVInformation to be included in an application for the variation of a condition imposed in connection with inclusion in the medical list

1.  Full name.

2.  Private address.

3.  Name and private address of each partner with whom the applicant practises.

4.  Whether the applicant wishes to practise as—

(a)a full-time doctor;

(b)a three-quarter-time doctor;

(c)a half-time doctor;

(d)a job-sharing doctor and the name of the other job-sharing doctor with whose hours the applicant’s hours are to be aggregated for the purposes of regulation 13(d); or

(e)a restricted doctor.

Regulation 18(2)

Part VInformation to be supplied by the agency with regard to doctors' lists

1.  The number of patients included in the doctor’s list, in each of the age-groups in accordance with the capitation fee payable in respect of them.

2.  The number of children included in the doctor’s list for whom he has undertaken to provide child health surveillance services.

3.  The number of patients included in the doctor’s list for whom a capitation fee under regulation 37(2)(o) is payable, in each group in accordance with the level of fee payable in respect of them.

4.  The number of patients included for whom fees and allowances are payable under regulation 37(2)(d) in respect of a rural practice.

Regulation 26(3)

Part VIInformation to be supplied by doctor applying for inclusion in the child health surveillance list

1.  Full name.

2.  Address of practice premises.

3.  Registration number in the Medical Register and date of first registration.

4.  Details of relevant medical experience after date of first registration (and, if appropriate, before that date) during the last 5 years, together with any references.

5.  Title of any post-graduate qualification held and date awarded.

Regulation 26(7) and (12)

Part VIICriteria for inclusion and retention in the child health surveillance list

1.  A doctor will have his name included in the child health surveillance list if he fulfils one or more of the following criteria which relate to the period of 5 years immediately preceding application:

(a)he has held a full-time 6 month recognised post or part-time equivalent, in hospital paediatrics working mainly, that is to say more than 50% of the time, in medical or community paediatrics; or

(b)he has held a full-time recognised post or part-time equivalent as a Clinical Medical Officer in community health working mainly, that is to say, more than 50% of the time, in child community health; or

(c)he has successfully completed a Child Health Surveillance training programme recognised jointly by the Regional Advisers in General Practice and Paediatrics. A doctor who has not had regular clinical paediatric experience in the previous 5 years will require recognised practical training; or

(d)he has obtained membership of the Royal College of General Practitioners after 1992 by examination.

2.  In order to ensure continued inclusion in the child health surveillance list at each quinquennial review, a doctor shall confirm to the Board his attendance at an update course, approved by the Northern Ireland Council for Postgraduate Medical and Dental Education(57), within the last 5 years.

Regulation 35(3)

Part VIIIInformation to be supplied by doctor applying for inclusion in the minor surgery list

1.  Full name.

2.  Address of practice premises.

3.  Registration number in the Medical Register and date of first registration.

4.  Details of relevant medical experience after date of first registration (and, if appropriate, before that date) during the last 5 years together with any references.

5.  Details of premises and equipment to be used.

6.  Title of any post-graduate qualification held and date awarded.

Regulation 35(7) and (12)

Part IXCriteria for inclusion and retention in the minor surgery list

1.  Subject to paragraph 4, a doctor shall have his name included in the minor surgery list if he has provided the Board with a declaration that he is capable of carrying out all the procedures in respect of all the conditions listed in Schedule 7 and satisfies the conditions in paragraphs 3 and 5;

AND EITHER

(a)he has provided the Board with a certificate of satisfactory completion of a training course approved by the Northern Ireland Council for Postgraduate Medical and Dental Education, which he has attended within the 5 years prior to application for inclusion in the list;

OR

(b)he has obtained a Fellow of the Royal College of Surgeons qualification within the 10 years prior to application for inclusion in the list;

AND

(c)he will provide evidence that he complies with current guidance given by the Department on the protection of health care workers and patients from Hepatitis B;

AND

(d)a doctor shall confirm to the Board that he will carry out an annual self audit of minor surgery procedures including the minimum data set:—

(i)total number of procedures performed;

(ii)number of procedures by type (as outlined in Schedule 7);

(iii)number of complications and type;

(iv)number of complications which required referral for further investigation or treatment; and

(v)number of specimens sent for histology.

Quinquennial Review

2.  The criteria to be met by a doctor to ensure the continued inclusion of his name in the minor surgery list at quinquennial review are—

(a)he has carried out, during the preceding 5 years, an average of at least 20 minor surgery procedures per year;

AND

(b)he has provided for the Board an audit report of all procedures carried out during the previous 5 years indicating:—

(i)total number of procedures performed;

(ii)number of procedures by type (as outlined in Schedule 7);

(iii)number of complications and type;

(iv)number of complications which required referral for further investigation or treatment; and

(v)number of specimens sent for histology;

AND

(c)subject to sub-paragraph (d) he has confirmed for the Board his attendance within the last 5 years at an update course on minor surgery approved by the Northern Ireland Council for Postgraduate Medical and Dental Education;

(d)for doctors whose names were included in the minor surgery list prior to the date of issue of these criteria the first review shall take place 5 years after that date. Thereafter the review shall take place either 5 years from the previous review or 5 years after the doctor’s name was first included in the minor surgery list.

Premises/facilities

3.  A doctor shall demonstrate to the Board that the premises/facilities within which he provides, or is proposing to provide, minor surgery services meet the following standards:

(a)physical facilities with:—

(i)sufficient space;

(ii)an appropriate couch or table;

(iii)proper lighting;

(iv)appropriate arrangements for privacy;

(v)hand-washing facilities; and

(vi)proper arrangements for the provision of sterile equipment (other than by boiling alone), compatible with modern surgical practice;

(b)resuscitation facilities and arrangements shall be in place to deal with situations such as anaphylactia or other similar reactions to local anaesthetic drugs.

4.  Where a doctor’s name has previously been included in the minor surgery list of any Health Board in Scotland, or Health Authority in England or Wales, the Board may grant his application under regulation 35 without the doctor having to provide further proof of fulfilling the criteria set out in paragraphs 1 and 2.

5.  Any other person in the practice involved in minor surgery procedures shall comply with guidance given from time to time by the Department on the protection of health care workers and patients from Hepatitis B.

Regulations 2 and 27(3) and (4)

SCHEDULE 4Child Health Surveillance Services

1.  The services referred to in regulation 27(3)(a) shall comprise—

(a)the monitoring—

(i)by the consideration of information concerning the child received by or on behalf of the doctor; and

(ii)on any occasion when the child is examined or observed by or on behalf of the doctor (whether pursuant to sub-paragraph (b) or otherwise),

of the health, well-being and physical, mental and social development (all of which characteristics are referred to in this Schedule as “development”) for the child while under the age of 5 years with a view to detecting any deviations from normal development;

(b)the examination of the child, by or on behalf of the doctor, on so many occasions and at such intervals as shall have been agreed by the Board in whose area the child resides, for the purposes of the provision of child health surveillance services generally in that area.

2.  The records mentioned in regulation 27(3)(b) shall comprise an accurate record of—

(a)the development of the child while under the age of 5 years, compiled as soon as is reasonably practicable following the first examination mentioned in paragraph 1(a) and, where appropriate, amended following each subsequent examination mentioned in that sub-paragraph; and

(b)the responses (if any) to offers made to the child’s parent for the child to undergo any examination referred to in paragraph 1(b).

3.  The information mentioned in regulation 27(3)(c) shall comprise—

(a)a statement, to be prepared and sent to the relevant Board as soon as is reasonably practicable following any examination referred to in paragraph 1(a), of the procedures undertaken in the course of that examination and of the doctor’s findings in relation to each such procedure;

(b)such further information regarding the development of the child while under the age of 5 years as the relevant Board may request.

Regulation 34(1)(c) and (4)

SCHEDULE 5Maternity Medical Services

1.  A doctor with whom a woman has made an arrangement under regulation 34(2) for the provision of maternity medical services during the ante-natal period shall take all reasonable steps to secure that she receives all necessary personal medical services connected with the pregnancy from the time when the arrangement is made until—

(a)where the pregnancy is terminated by miscarriage, the woman has received all necessary personal medical services in connection with the miscarriage; or

(b)where the woman goes into labour, the date of the onset of that labour.

2.  A doctor with whom a woman has made an arrangement under regulation 34(2) for the provision of maternity medical services during labour shall take all reasonable steps to secure that she receives all necessary personal medical services during that labour.

3.  A doctor with whom a woman has made an arrangement under regulation 34(2) for the provision of maternity medical services during the post-natal period shall—

(a)take all reasonable steps to secure that the woman receives all necessary personal medical services related to the recent pregnancy or labour during the post-natal period; and

(b)where the pregnancy has resulted in the birth of a live baby, render all necessary personal medical services to that baby during the period of 14 days following its birth unless, during that period, another doctor has accepted the baby for inclusion in his list pursuant to an application made on the baby’s behalf under regulation 19(2).

4.  A doctor with whom a woman has made an arrangement under regulation 34(2) for the provision of a post-natal examination shall, not less than 6 weeks nor more than 12 weeks after the conclusion of her pregnancy—

(a)undertake a full post-natal examination of the woman; and

(b)take all reasonable steps to ensure that the woman is informed of the need for any further treatment she may require.

5.  Where the doctor is aware that an arrangement under regulation 34(2) is about to be terminated under regulation 34(6) he shall take all reasonable steps to ensure that the woman is informed of the manner in which she may make a further such arrangement with another doctor.

6.  The doctor shall be relieved of his obligations under paragraph 1, 2, 3 or 4, as the case may be,—

(a)during any period when the woman is outside the doctor’s practice area and is not present at any other place where, pursuant to paragraph 14 of the terms of service, the doctor is obliged to visit her;

(b)where it is proposed that the woman’s labour should take place in a hospital, to the extent that responsibility for her care has been taken over by the hospital; and

(c)where the woman has been admitted to a hospital as an in-patient, to the extent that her care has been taken over by the hospital.

Regulation 29(1)

SCHEDULE 6Constitution of the Obstetric Committee

1.  The membership of the Obstetric Committee shall consist of—

(a)4 doctors in active obstetric practice;

(b)one consultant obstetrician in active domiciliary consultative obstetric practice;

(c)an administrative medical officer in the employment of a Board; and

(d)a medical officer of the Department,

appointed by the Department, after consultation with such organisations as may be recognised by the Department as representative of the appropriate branches of the medical profession.

2.  The chairman and vice-chairman shall be appointed from the members of the Obstetric Committee by the Department, after consultation with the organisations referred to in paragraph 1.

3.  All members shall be appointed for a period of 3 years.

4.  A member may be reappointed to the Obstetric Committee on the expiration of his term of office.

5.  A member may resign from the Obstetric Committee by giving notice in writing to the Department and a member who is appointed as being a person actively engaged in obstetric practice shall be deemed to have resigned if he ceases to be so engaged.

6.  In the case of a vacancy in membership occurring, a person shall be appointed to fill that vacancy for the remainder of the period for which his predecessor was appointed.

7.  The chairman or vice-chairman and 2 other members shall form a quorum and, in the case of equality of votes, the chairman or vice-chairman, as the case may be, shall have a second or casting vote.

8.  The procedure shall be such as may be determined by the Obstetric Committee.

Regulations 2, 35(1) and 36(1), (3) and (5), and Schedule 3, Part IX, paragraphs 1 and 2

SCHEDULE 7Minor Surgery Procedures

Injections
  • intra-articular

  • peri-articular

  • varicose veins

  • haemorrhoid

Aspirations
  • joints

  • cysts

  • bursae

  • hydrocele

Incisions
  • abscesses

  • cysts

  • thrombosed piles

Excisions
  • sebaceous cysts

  • lipoma skin lesions for histology

  • intradermal naevi, papilloma, dermatofibroma and similar conditions

  • warts

  • removal of toe nails (partial and complete)

Curette cautery and cryocautery
  • warts and verrucae

  • other skin lesions (for example molluscum contagiosum)

Other
  • removal of foreign bodies

  • nasal cautery

Regulation 3(2)

SCHEDULE 8Doctors' Hours

Schedule 2 paragraph 36(9)(a)

Part IInformation to be included with any application in relation to the times at which a doctor is to be available

1.  The address of the proposed practice premises.

2.  The days in each week during which the doctor will normally be in attendance at the practice premises and available for consultation by his patients.

3.  The hours of each such attendance by the doctor.

4.  The hours of any attendance by the doctor on those occasions when he is not usually available to provide all the personal medical services specified in paragraph 13 of the terms of service (for example, for providing emergency treatment only).

5.  The frequency, duration and purpose of any clinic provided by the doctor.

6.  The estimated total time each week to be spent making any domiciliary visits.

7.  The doctor’s proposals for notifying patients of his availability at the times and places approved by the Board under paragraph 36 of the terms of service.

8.  The terms of any condition imposed by the Board under paragraph 36(11)(b) of the terms of service.

Schedule 2 paragraph 36(9)(b)(i)

Part IIAdditional information to be included in any application by a doctor who is a restricted services principal or a restricted list principal

1.  In the case of a restricted services principal—

(a)the proposed allocation of the total number of hours for which he is normally to be available in any week between each category of services provided; and

(b)where different services are to be provided at different places, the place at which each category of services provided.

2.  In the case of a restricted list principal, the name, address and nature of any establishment or organisation with which his patients are connected.

Schedule 2 paragraph 36(9)(b)(ii)

Part IIIAdditional information to be included in any application by a doctor who seeks normally to be available on only 4 days in each week

1.  A brief description of each health-related activity with reference to which the application is made.

2.  The days in each week during which the doctor will be undertaking that activity.

3.  The number of hours in each week which are likely to be occupied in the course of such activity.

Schedule 2 paragraph 38(2)

Part IVIllustrative list of health-related activities

Regulation 3(2) and Schedule 2 paragraph 42(1)

SCHEDULE 9List of Medical Certificates

Column 1Column 2
Description of Medical CertificateShort title of enactment under or for purpose of which certificate required

1.  To support a claim or to obtain payment either personally or by proxy; to prove inability to work or incapacity for self-support for the purposes of an award by the Department; or to enable proxy to draw pensions etc.

Naval and Marine Pay and Pensions Act 1865(58)

Air Force (Constitution) Act 1917(59)

Pensions (Navy, Army, Air Force and Mercantile Marine) Act 1939(60)

Personal Injuries (Emergency Provisions) Act 1939(61)

Pensions (Mercantile Marine) Act 1942(62)

Polish Resettlement Act 1947(63)

Social Security Contributions and Benefits (Northern Ireland) Act 1992(64)

Social Security Administration (Northern Ireland) Act 1992(65)

2.  To establish pregnancy for the purpose of obtaining welfare foods.

Article 13 of the Social Security (Northern Ireland) Order 1988(66)

3.  To establish fitness to receive inhalational analgesia in childbirth.

Nurses, Midwives and Health Visitors Act 1979(67)

4.  To secure the registration of still-births.

Births and Deaths Registration (Northern Ireland) Order 1976(68)

5.  To enable payment to be made to an institution or other person in case of mental disorder of persons entitled to payment from public funds.

Mental Health (Northern Ireland) Order 1986(69)

6.  To establish unfitness for jury service.

Juries (Northern Ireland) Order 1996(70)

7.  To support late application for reinstatement in civil employment or notification of non-availability to take up employment, owing to sickness.

Reserve Forces (Safeguard of Employment) Act 1985(71)

Reserve Forces Act 1980(72)

Reserve Forces Act 1996(73)

8.  To enable a person to be registered as an absent voter on grounds of physical incapacity.

Representation of the People Act 1985(74)

Northern Ireland Assembly Elections Order 1982(75)

The Local Elections (Northern Ireland) Order 1985(76)

9.  To support application for certificates conferring exemption from charges in respect of drugs, medicines and appliances.

Health and Personal Social Services (Northern Ireland) Order 1972

Regulation 3(2), Schedule 2 paragraph 49(1)

SCHEDULE 10Drugs and other Substances not to be Prescribed for supply under Pharmaceutical Services

Regulation 3(2),Schedule 2 paragraphs 1 and 49(2)

SCHEDULE 11Drugs and other Substances to be Prescribed for supply under Pharmaceutical Services only in certain circumstances

Column 1Column 2Column 3
DrugPatientCondition
Acetylesteine GranulesAny patientTreatment of abdominal complications associated with cystic fibrosis
CarbocisteineA patient under the age of 18 who has undergone a tracheostomyTreatment of any condition which, through damage or disease, affects the airways and has required a tracheostomy
ClobazamAny patientTreatment of epilepsy
Cyanobalamin TabletsA patient who is a vegan or who has a proven vitamin B12 deficiency of dietary originTreatment or prevention of vitamin B12 deficiency
Locabiotal AerosolAny patientTreatment of infection and inflammation of the oxopharyone
Niferex Elixir 30 ml Paediatric Dropper BottleInfants born prematurelyProphylaxis and treatment of iron deficiency
Nizoral CreamAny patientTreatment of seborrhoeic dermatitis and pityriasis versicolor
  • 10.10 Cleaning and Disinfecting Solution

  • 10.10 Rinsing and Neutralising Solution

  • Alcon Salette Aerosol Saline Solution

  • AMI-10 Rinsing and Storage Solution

  • Amiclear Contact Lens Cleanser Tablets

  • Amidose Saline Solution 30 ml

  • Barnes — Hind No. 4 Cleaner

  • Barnes — Hind Cleaning and Soaking Solution

  • Barnes — Hind Intensive Cleaner

  • Barnes — Hind Wetting and Soaking Solution

  • Bausch and Lomb Cleaning Tablets

  • Bausch and Lomb Concentrated Cleaner (for Hard Lenses)

  • Bausch and Lomb Daily Lens Cleaner

  • Bausch and Lomb Saline Solution

  • Bausch and Lomb Soaking and Wetting Solution

  • Boots Hard Lens Soaking Solution

  • Boots Hard Lens Wetting Solution

  • Boots Soft Lens Cleaning Solution

  • Boots Soft Lens Comfort Solution

  • Boots Soft Lens Soaking Solution

  • Boston Lens Cleaning Solution

  • Boston Lens Wetting and Soaking Solution

  • Clean and Soak

  • Clerz Lubricating, cleaning and comfort sachets

  • Clerz Lubricating and Rewetting Eye Drops

  • Contactaclean Cleaning Solution

  • Contactasoak Disinfecting and Soaking Solution

  • Contactasol 02 Care Solution

  • Contactasol Complete Care All-In-One Solution

  • Contactasol Solar Saline Spray

  • Contactasol Wetting Solution

  • Flexcare Soft Lens Solution

  • Flexsol Solution

  • Hexidin Solution

  • Hydrocare Boiling/Rinsing Solution

  • Hydrocare Cleaning and Soaking Solution

  • Hydrocare Preserved Saline Solution

  • Hydrocare Protein Remover Tablets

  • Hydroclean Solution

  • Hydron Europe Cleaning Solution

  • Hydron Europe Soaking Solution

  • Hydron Europe Solusal

  • Hydron Europe Solution Comfort

  • Hydrosoak Disinfecting and Soaking Solution

  • Hydrosol Comfort Solution

  • Kelsoak 2 Solution

  • Kelvinol 2 Wetting Solution

  • LC65 Cleaning Solution

  • Lensept Solution

  • Lensine 5 All in One Solution

  • Lensplus Sterile Saline Spray

  • Lensrins Solution

  • Liquifilm Wetting Solution

  • Mediclean Soft Lens Solution

  • Medisoak Soft Lens Solution

  • Mira Flow Cleaning Solution

  • Mira Flow Soft Lens Solution

  • Mira Soak Soft Lens Soaking Solution

  • Mira Sol Soft Lens Solution

  • Oxysept 1 Disinfecting Solution

  • Oxysept 2 Rinsing, Neutralising and Storing Solution

  • Perform 1 Disenfecting Solution

  • Perform 2 Rinsing and Neutralising Solution

  • Pliagel Soft Lens Solution

  • Preflex Solution

  • Prymecare Tablets for Soft and Gas Permeable Lenses

  • Prymeclean Cleaning Solution for Soft Lenses

  • Prymesoak Soaking Solution for Soft Lenses

  • Soaclens Solution

  • Softab Soft Lens Care Tablets

  • Solusol Solution

  • Soquette Soaking Solution

  • Steri-Clens Solution

  • Steri-Solve Soft Lens Solution

  • Titan Hard Cleanser

  • Total All Purpose Solution

  • Transclean Cleaning Solution

  • Transdrop

  • Transoak Solution

  • Transol Solution

Any patientWhere contact lenses are indicated for a therapeutic reason

Regulation 3(2), Schedule 2 paragraph 51(1)

SCHEDULE 12Information to be Included in Practice Leaflets

Personal and professional details of the doctor

1.  Full name.

2.  Sex.

3.  Medical qualifications registered by the General Medical Council.

4.  Date and place of first registration as a medical practitioner.

Practice information

5.  The times approved by the Board during which the doctor is personally available for consultation by his patients at his practice premises.

6.  Whether an appointments system is operated by the doctor for consultations at his practice premises.

7.  If there is an appointments system, the method of obtaining a non-urgent appointment and the method of obtaining an urgent appointment.

8.  The method of obtaining a non-urgent domiciliary visit and the method of obtaining an urgent domiciliary visit.

9.  The doctor’s arrangements for providing personal medical services when he is not personally available.

10.  The address of any premises approved under paragraph 37 of Schedule 2 at which patients may be invited for treatment outside the hours for which the doctor is normally available pursuant to paragraph 36 of that Schedule.

11.  Where the doctor has made an out of hours arrangement under paragraph 20(2) of Schedule 2, the name and address of the doctor with whom the arrangement has been made, the times during which it applies and details of the arrangements whereby the doctor’s patients may contact the doctor concerned.

12.  The method by which patients are to obtain further prescriptions for the same drug (repeat prescriptions) from the doctor.

13.  The arrangements (if any) for dispensing prescriptions.

14.  If the doctor provides clinics for his patients, their frequency, duration and purpose.

15.  The numbers of staff, other than doctors, assisting the doctor in his practice and a description of their roles.

16.  Whether or not the doctor provides child health surveillance services, contraceptive services, maternity medical services or minor surgery services.

17.  Whether the doctor works single-handed, in partnership, part-time or as a job-sharing doctor, or within a group practice of doctors.

18.  The nature of any arrangements whereby the doctor or his staff receive patients' comments on his provision of general medical services.

19.  The geographical boundary of his practice area by reference to a sketch, diagram or plan.

20.  Whether the doctor’s premises have suitable access for all disabled patients and, if not, the reasons why they are unsuitable for particular types of disability.

21.  If an assistant is employed, details for him as specified in paragraphs 1 to 4.

22.  If the practice is either a general practitioner training practice for the purposes of the Medical Practitioners (Vocational Training) Regulations (Northern Ireland) 1979(77) or undertakes the teaching of medical students, the nature of arrangements for drawing this fact to the attention of patients.

Regulation 3(2), Schedule 2 paragraph 56(2)

SCHEDULE 13Information to be Provided in Annual Reports

1.  Particulars of the doctor’s other commitments as a medical practitioner, including—

(a)a description of any posts held; and

(b)a description of all work undertaken,

and including, in each case, the annual hourly commitment, except that where a doctor has notified the Board of such other commitments in a previous annual report, the report need only contain information relating to any changes in those commitments.

2.  As respects orders for drugs and appliances, the doctor’s arrangements for the issue of further prescriptions of the same drug or appliance to patients.

3.  Information relating to the referral of patients to other services under the Order during the period of the report—

(a)as respects those by the doctor to specialists—

(i)the total number of patients referred as in-patients;

(ii)the total number of patients referred as out-patients,

by reference in each case to the clinical speciality which applies and specifying in each case the name of the hospital concerned;

(b)the total number of cases of which the doctor is aware (by reference to the clinical speciality) in which a patient referred himself to services under the Order.

4.  Information relating to the numbers of patients on the doctor’s list—

(a)who are diabetic; and

(b)who are asthmatic.

5.  The number of complaints received in accordance with paragraph 52 of the terms of service.

Regulation 7

SCHEDULE 14Constitution of the Medical Committee

Membership

1.  The Medical Committee shall be constituted by the Agency and shall consist of a chairperson and 6 other members.

2.  The chairperson shall be a doctor on the medical list and shall be appointed by the Department.

3.  Four of the other members shall be doctors on the medical list and shall be appointed by the Agency, in consultation with the Department, from nominations submitted in accordance with paragraph 5.

4.  Two of the other members shall be lay persons and shall be appointed by the Agency, in consultation with the Department, from nominations submitted in accordance with paragraph 5.

5.  The nominations referred to in paragraphs 3 and 4 shall be obtained by the Agency in accordance with this paragraph:—

(a)each Board, after consultation with its Local Medical Committee, shall nominate at least 2 doctors on the medical list and, after consultation with its Health and Social Services Council, shall nominate at least 2 lay persons;

(b)the General Medical Services Committee of the British Medical Association (Northern Ireland) shall nominate at least 3 doctors on the medical list;

(c)the Northern Ireland Faculty of the Royal College of General Practitioners shall nominate at least 3 doctors on the medical list.

6.  To ensure that a quorum is present at meetings of the Medical Committee, the Agency, when constituting the Medical Committee, shall appoint, in consultation with the Department, an additional 4 doctors and 2 lay persons from the nominations submitted under paragraph 5 to deputise, as necessary, for absent members.

7.  The term of office of members and deputies shall be 3 years and a member may be re-appointed on the expiration of his term of office.

8.  Where the place of a member or deputy becomes vacant before the expiration of his term of office whether by death, resignation or otherwise, the vacancy shall be filled by the Agency, after consultation with the Department, from the list of nominations submitted under paragraph 5 and any person so appointed shall hold office for the remainder of the term of office of the former member.

9.  A member of the Medical Committee may resign his membership by giving notice in writing to the Agency, and a member who is appointed as being a doctor on the medical list shall be deemed to have resigned if he ceases to be included in the medical list.

Procedure at meetings

10.  Subject to paragraphs 11 and 12, any recommendation of the Medical Committee shall be that of the majority of those members who are present and voting at a meeting of the Committee.

11.  At any such meeting, 4 members of the Medical Committee shall form a quorum and, in the case of an equality of votes, the chairperson shall have a second or casting vote.

12.  A member may vote upon any matter which touches the interests of members of his profession (himself included) but shall not vote upon any matter touching only his individual professional interests.

13.  The proceedings of the Medical Committee shall not be invalidated by any vacancy in the membership of the Committee or by any defect in the appointment of their members.

14.  The Medical Adviser of the relevant Board shall have the right to attend a meeting of the Medical Committee to provide members with additional background information on any application made by a doctor in accordance with regulation 4(3), 8 or 10 in relation to that Board’s area and shall attend if the Chairperson of the Medical Committee so requests.

Regulation 44(2)

SCHEDULE 15Regulations Revoked

Column 1Column 2
CitationReference
Health and Personal Social Services GeneralS.R. & O. (N.I.) 1973
Medical and Pharmaceutical Services Regulations (Northern Ireland) 1973No. 421
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1975S.R. 1975 No. 180
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1976S.R. 1976 No. 285
Linguistic Knowledge for General Medical Services and General Dental Services (Northern Ireland) Regulations 1981S.R. 1981 No. 229
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1983S.R. 1983 No. 182
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1985S.R. 1985 No. 69
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1985S.R. 1985 No. 131
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1985S.R. 1985 No. 318
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1986S.R. 1986 No. 65
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1986S.R. 1986 No. 170
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1986S.R. 1986 No. 289
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1987S.R. 1987 No. 1
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1987S.R. 1987 No. 247
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1987S.R. 1987 No. 323
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1988S.R. 1988 No. 246
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1988S.R. 1988 No. 395
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1989S.R. 1989 No. 11
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1989S.R. 1989 No. 454
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1990S.R. 1990 No. 157
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1990S.R. 1990 No. 361
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1990S.R. 1990 No. 428
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1991S.R. 1991 No. 97
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1991S.R. 1991 No. 222
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1991S.R. 1991 No. 476
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1992S.R. 1992 No. 200
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1992S.R. 1992 No. 232
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1992S.R. 1992 No. 454
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1993S.R. 1993 No. 158
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1993S.R. 1993 No. 427
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1994S.R. 1994 No. 117
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1994S.R. 1994 No. 403
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1994S.R. 1994 No. 500
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1995S.R. 1995 No. 56
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1995S.R. 1995 No. 126
General Medical and Pharmaceutical Services (Amendment No. 3) Regulations (Northern Ireland) 1995S.R. 1995 No. 487
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1996S.R. 1996 No. 136
General Medical and Pharmaceutical Services (Amendment) Regulations (Northern Ireland) 1997S.R. 1997 No. 190
General Medical and Pharmaceutical Services (Amendment No. 2) Regulations (Northern Ireland) 1997S.R. 1997 No. 264

Explanatory Note

(This note is not part of the Regulations.)

These Regulations consolidate, with amendments, those provisions of the General Medical and Pharmaceutical Services Regulations (Northern Ireland) 1973 (the 1973 Regulations) which relate to general medical services. The provisions of the 1973 Regulations which relate to pharmaceutical services are consolidated, with amendments, in the General Pharmaceutical Services Regulations (Northern Ireland) 1997. These Regulations therefore regulate the terms on which general medical services are provided under the Health and Personal Social Services (Northern Ireland) Order 1972.

The principal changes effected by the Regulations are the following.

The Regulations include criteria which doctors must meet for inclusion in, and retention on, the child health surveillance list and the minor surgery list (Regulations 26 and 35 and Parts VII and IX of Schedule 3).

The Regulations also contain revised procedures to be used in determining whether or not a substance supplied or ordered by a doctor for provision by a chemist is a drug the provision of which forms part of pharmaceutical services (regulation 40).

The Regulations are amended to provide that a doctor shall inform the Health and Social Services Board of the name of any doctor who has responsibility for his practice during any period of absence of more than 14 days (paragraph 25(2) of Schedule 2).

(3)

Article 55 was amended by Article 5 of S.I. 1991/194 (N.I. 1)

(5)

New paragraphs (2) to (2D) of Article 63 were substituted for Article 63(2) by Article 5 of S.I. 1986/2023 (N.I. 20)

(8)

14 & 15 Geo. 6 c. 65

(12)

Paragraphs 8A and 8B of Part I of Schedule 11 were inserted by Article 4 of S.I. 1995/2704 (N.I. 14)

(13)

1968 c. 34; as amended by S.I. 1995/755 (N.I. 2), Schedule 9, paragraph 42; See also S.I. 1973/2163, Article 2(1) and Schedule 1

(14)

1968 c. 29; section 2(a) was substituted by Article 13(5) and (6) of S.I. 1989/1344 (N.I. 15)

(15)

Article 56 was amended by Article 12 of S.I. 1978/1907 (N.I. 26), Article 5 of S.I. 1981/432, Article 7 of S.I. 1986/2229 (N.I. 24) and Article 29 of, and Part I of Schedule 6 to, S.I. 1991/194 (N.I. 1)

(16)

Article 56(2) was amended by Articles 29 and 35 of, and Part I of Schedule 6 to, S.I. 1991/194 (N.I. 1)

(17)

Article 56(4C) was inserted by Article 7 of S.I. 1986/2229 (N.I. 24)

(18)

Article 56(2A) was inserted by Article 5(1)(b) of S.I. 1981/432 and amended by Article 29 of S.I. 1991/194 (N.I. 1)

(24)

Article 56(2A) was inserted by Article 5(1)(b) of S.I. 1981/432 and amended by Article 29 of S.I. 1991/194 (N.I. 1)

(28)

Paragraph 8B of Schedule 11 was inserted by Article 4 of S.I. 1995/2704 (N.I. 14)

(38)

Article 63 was amended by Article 14 of S.I. 1978/1907 (N.I. 26), Article 5(1) of S.I. 1986/2023 (N.I. 20), Article 31 of S.I. 1991/194 (N.I. 1) and Article 3 of S.I. 1992/2671 (N.I. 18)

(43)

Article 56 was amended by Article 12 of S.I. 1978/1907 (N.I. 26), Article 5 of S.I. 1981/432, Article 7 of S.I. 1986/2229 (N.I. 24) and Article 29 of S.I. 1991/194 (N.I. 1)

(47)

Article 31 was substituted by Article 3(9) of S.I. 1966/2249 (N.I. 24)

(49)

Article 62(1) was amended by Article 3 of S.I. 1984/1158 (N.I. 8) and Article 8(1) of S.I. 1988/2249 (N.I. 24)

(50)

Paragraph (6) of Article 62 was inserted by Article 8(2) of S.I. 1988/2249 (N.I. 24)

(52)

S.R. 1986 No. 52; the relevant amending Regulations are S.R. 1987 No. 68 and S.R. 1988 No. 206

(57)

The Northern Ireland Council for Postgraduate Medical and Dental Education was appointed by the Department of Health and Social Services under powers conferred by section 1(3) of the Ministries of Northern Ireland Act (Northern Ireland) 1921 and paragraph 2 of Schedule 1 to the Northern Ireland Act 1974

(58)

28 & 29 Vict. c. 73

(59)

7 & 8 Geo. 5 c. 51

(60)

2 & 3 Geo. 6 c. 83

(61)

2 & 3 Geo. 6 c. 82

(62)

5 & 6 Geo. 6 c. 26

(63)

10 & 11 Geo. 6 c. 19

(66)

S.I. 1988/594 (N.I. 2); Article 13 is amended by Schedule 7 to the Social Security (Northern Ireland) Order 1990 (S.I. 1990/1511 (N.I. 15)) and by paragraph 35(1) and (2) of Schedule 2 to the Social Security (Consequential Provisions) (Northern Ireland) Act 1992 (c. 9)

(68)

S.I. 1976/1041 (N.I. 14) as amended by the Still-Birth (Definition) (Northern Ireland) Order 1992 (S.I. 1992/1310 (N.I. 10))

(76)

S.I. 1985/454 substituted by Schedule 2 to S.I. 1987/168