The National Health Service (Fund-holding Practices) Regulations 1996

Purchase of goods and services

20.—(1) Subject to paragraphs (3) to (11), the members of a fund-holding practice shall apply the allotted sum so as to secure the purchase of such of the goods and services, other than general medical services, referred to in paragraph (2) as are necessary for the proper treatment of individuals on the lists of patients of the members of the practice and are appropriate in all the circumstances having regard, in particular, to the needs of all those individuals.

(2) The goods and services referred to in paragraph (1) are the goods and services specified, in the case of standard fund-holding practices in Part I, and in the case of community fund-hold practices in Part II, of a list approved from time to time by the Secretary of State for the purposes of this regulation.

(3) Where the list mentioned in paragraph (2) includes services in connection with the termination of pregnancy but the members of a fund-holding practice do not wish to purchase such services in any financial year, they may give notice to that effect to the Health Authority by 1st July in the preceding year.

(4) The cost of any such services in connection with the termination of pregnancy which are provided to individuals on the lists of patients of members of the practice in the financial year in question shall be met by the Health Authority whose primary functions include the provision of goods and services to those individuals—

(a) where the members of the practice have given notice as mentioned in paragraph (3); or

(b) where a patient of a member of a practice either refers herself for such services to a Health Authority or an NHS Trust or is referred by a doctor who is not a member of the fund-holding practice.

(5) Where the list mentioned in paragraph (2) includes district nursing or health visiting services or both, the members of a fund-holding practice shall enter into at least one NHS contract, to which the Health Authority has consented in writing in accordance with paragraph (6), for the purchase of such of those services as are included in that list.

(6) The Health Authority shall consent to such an NHS contract as is referred to in paragraph (5) if it is satisfied that—

(a) the proposed provider is either a Health Authority or an NHS Trust;

(b) the proposed provider either has itself provided, or has assumed responsibility for the relevant establishments or facilities of a body which provided, such district nursing or health visiting services or both, whether under an NHS contract or not and whether to the patients of the members of the fund-holding practice or not, for the whole of the calendar year ending on the date from which the proposed services are to be purchased; and

(c) the volume of district nursing and health visiting services which the members of the practice propose to purchase is at least that which the Secretary of State, in his determination of the allotted sum payable to the members of the fund-holding practice, determined was expected to be purchased for the benefit of individuals on the lists of patients of members of the fund-holding practice.

(7) The members of a fund-holding practice shall not purchase any of the goods or services specified in a list approved under paragraph (2) for an individual who is on the lists of patients of a member of the practice from any provider with which any member of the practice is connected unless—

(a) the Health Authority has consented in writing to the purchase of those goods or services from that provider; or

(b) it is impracticable, having regard to the condition of the patient, to obtain the consent and no alternative provider is available; or

(c) the provider is a health service body other than a fund-holding practice.

(8) The Health Authority shall not consent to the purchase of any goods or services from a provider with which a member of the practice is connected unless it is satisfied either that no member of the practice will receive any payment from the allotted sum, whether directly or indirectly, more than half of which is attributable to treatment given to individuals who are on the lists of patients of members of the practice, or that such payments will be made in accordance with regulation 24.

(9) Where the members of a practice have obtained the consent of the Health Authority under paragraph (6) or (7), the members of the practice shall give notice to the Health Authority—

(a) in the case of consent under paragraph (6), where they propose any reduction in the level of the services in respect of which the consent was given; and

(b) in the case of consent under paragraph (7), of any change either in the facilities available at, or the charges made by, the provider in respect of which the consent was given.

(10) Where a Health Authority receives notice as mentioned in paragraph (9), it shall either confirm or withdraw its consent.

(11) For the purposes of this regulation—

(a) “district nursing services” means services provided by or under the direction of a nurse who is employed by a Health Authority or an NHS Trust and who has a qualification in district nursing recorded in the register of qualified nurses, midwives and health visitors prepared and maintained by the Central Council for Nursing, Midwifery and Health visiting in accordance with section 10 of the Nurses, Midwives and Health Visitors Act 1979(1);

(b) “health visiting services” means services provided by or under the direction of a health visitor who is employed by a health authority or an NHS Trust and whose name is included in Part II of the register of qualified nurses, midwives and health visitors prepared and maintained by the Central Council for Nursing, Midwifery and Health Visiting in accordance with section 10 of the Nurses, Midwives and Health Visitors Act 1979;

(c) a member of a fund-holding practice shall be treated as connected with a provider if—

(i) he is employed by, or is a close relative of a person who is employed by, the provider,

(ii) where the provider is a company, he is a director of the company or a partner of or employed by or a close relative of a person who is a director of the company,

(iii) he is in partnership with or is a close relative of a person who is in partnership with the provider,

(iv) where the provider is a fund-holding practice he is a close relative of a member of that practice,

(v) where the provider is an individual, he is a close relative of that individual,

(vi) he has a beneficial interest in the securities of the provider, or

(vii) he provides or has provided any services to that provider,

and in this sub-paragraph “close relative” means a husband, wife, brother, sister, father, mother, son or daughter; and

(d) “provider” means any person or body with whom the members of a fund-holding practice contract or propose to contract for the purchase of any of the goods and services specified in the list mentioned in paragraph (2).

(1)

1979 c. 36. See the Nurses, Midwives and Health Visitors (Parts of the Register) Order 1983 (S.I. 1983/67), amended by S.I. 1989/104 and S.I. 1989/1456 and the Nurses, Midwives and Health Visitors Rules Approval Order 1983 (S.I. 1983/873) amended by S.I. 1989/1456.