The National Health Service (General Medical and Pharmaceutical Services) (Scotland) Amendment (No.2) Regulations 1989

New Paragraphs (newly registered patients, patients not seen within 3 years, patients aged 75 years and over)

8.  After paragraph 10 (treatment of patients) there shall be inserted the following paragraphs:—

“Newly registered patients

10A.— (1) Subject to sub-paragraphs (4) to (10), where a patient has been accepted on the list of a doctor under paragraph 6 or assigned to such a list under regulation 16, the doctor shall, in addition 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 10(3)(b), to render personal medical services to that patient.

(2) Where a patient (or, in the case of a patient who is a child, the appropriate person in relation to that child) agrees that he, or in the case of a child, that the child will participate in such a consultation as is mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) seek details as to the medical history of the patient 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 or unemployment, 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 height, weight and blood pressure, and

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

(c) record, in the records maintained in relation to the patient pursuant to paragraph 17, his findings arising out of the details supplied by or in relation to, 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; and

(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, discuss with the patient (or, where the patient is a child, the appropriate person) the conclusions the doctor has drawn as a result of the consultation as to the state of the patient’s health.

(3) In sub-paragraphs (2) and (4) of this paragraph and in paragraph 10B(5)(e) “the appropriate person”, in relation to a child, is a person who has the right under regulation 35 to choose on behalf of the child the person by whom general medical services are to be provided for the child.

(4) On each occasion where a doctor invites a patient or, where the patient is a child, the appropriate person, to participate in a consultation pursuant to 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, where the patient is a child, to the appropriate person, at the address recorded in the medical records kept for the patient as being his last home address or that of the appropriate person, as the case may be;

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

(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 his medical records, advise the Board accordingly.

(5) A doctor shall not be obliged to offer a consultation pursuant to sub-paragraph (1)—

(a) if he is a restricted services principal;

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

(c) to any patient who, immediately before joining the list of the doctor, was a patient of a partner of the doctor and who, during the 12 months immediately preceding the date of his acceptance or assignment to his current doctor’s list, had participated in a consultation pursuant to 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 Secretary of State has, pursuant to paragraphs (6) to (9), deferred the doctor’s obligation under paragraph (1).

(6) Where a doctor assumes responsibility for a list of patients on his succession to a vacant medical practice or otherwise becomes responsible for a significant number of new patients within a short period, he may apply, in accordance with sub-paragraph (7), 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.

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

(8) Within 2 months of receiving an application the Board shall decide it—

(a) by approving the application;

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

(c) by refusing the application,

and shall give written notice of its decision and, where it refuses the application or grants it subject to conditions, of its reasons for refusal or for such conditions, and of the doctor’s right of appeal under paragraph (9).

(9) A doctor may appeal in writing to the Secretary of State against any refusal of an application, or against any condition subject to which an application is approved by a Board pursuant to sub-paragraph (8)(b), and on determining such an appeal the Secretary of State shall—

(a) either confirm the Board’s decision or substitute his own determination for the decision of the Board, and

(b) give to the doctor written notice of his decision and of his reasons therefor.

Patients not seen within 3 years

10B.— (1) A doctor shall, without prejudice and in addition to any other obligations in the terms of service, invite each patient on his list who appears to him—

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

(b) to have neither—

(i) within the 3 years preceding the date of the offer attended either a consultation with, or a clinic provided by, any doctor, nor

(ii) within the 12 months preceding the date of the offer been offered a consultation in accordance with this sub-paragraph by any doctor,

to participate in a consultation at his practice premises 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 a doctor who is a restricted services principal.

(3) In the case of any patient who is on the doctor’s list on 1st April 1990, the first invitation to participate in a consultation pursuant to sub-paragraph (1) shall be made no later than 1st April 1991.

(4) When inviting a patient to participate in a consultation pursuant to sub-paragaph (1) a doctor shall comply with the requirements of paragraph 10A(4).

(5) Where a patient agrees to participate in a consultation mentioned in sub-paragraph (1), the doctor shall, in the course of that consultation—

(a) where appropriate seek details from the patient as to the medical history of the patient, 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 or unemployment, 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 height, weight and blood pressure, and

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

(c) record, in the records maintained in relation to the patient pursuant to paragraph 17, his findings arising out of the details supplied by or in relation to, 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; and

(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, discuss with the patient (or, where the patient is a child, the appropriate person) 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

10C.— (1) Subject to sub-paragraph (2), a doctor shall, without prejudice and in addition to any other obligations under the terms of service, in each period of 12 months beginning on 1st April in each year—

(a) invite each patient 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 such a patient.

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

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

(4) An invitation made by a doctor pursuant to sub-paragraph (1) shall be made—

(a) in the case of a patient who is over the age of 75 years and is on the doctor’s list on 31st March 1990, not later than 1st April 1991;

(b) in the case of a patient who attains the age of 75 years on or after 1st April 1990, within 12 months after his 75th birthday;

(c) in the case of a patient who—

(i) is accepted by the doctor pursuant to paragraph 6, or is assigned to him pursuant to regulation 16, after 1st April 1990, and

(ii) who has attained the age of 75 years when he is so accepted or assigned,

within 12 months after the date on which he is so accepted or assigned.

(5) A doctor shall, when making an assessment following a consultation under sub-paragraph (1), record in the patient’s medical records kept pursuant to paragraph 17 his observations made of any matter which appears 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 10A(4), as if that sub-paragraph referred to 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.”.