The National Health Service (General Medical Services) Amendment Regulations 2002

Citation, commencement, extent and interpretation

1.—(1) These Regulations may be cited as the National Health Service (General Medical Services) Amendment Regulations 2002 and shall come into force on 1st April 2002.

(2) These Regulations extend to England only.

(3) In these Regulations “the principal Regulations” means the National Health Service (General Medical Services) Regulations 1992(1).

(4) The principal Regulations shall be amended in accordance with the following provisions of these Regulations.

Amendment of regulation 2

2.  In regulation 2(1) (interpretation), omit the definition of “Medical Practices Committee”.

Amendment of Part II of the principal Regulations

3.  In regulation 4 (medical list), in paragraphs (3) and (5)(f) for “by the Medical Practices Committee” in each place those words occur substitute “by the Health Authority”.

4.—(1) Regulation 5A (preferential right to be included in medical list) shall be amended in accordance with the following paragraphs.

(2) In paragraph (2)(a) for “the Medical Practices Committee” substitute “the Health Authority”.

(3) In paragraph (2)(b) for “under section 33(4)(b) of the Act” substitute “under regulation 13(1)(c)”.

(4) Omit paragraph (4).

5.  In regulation 6 (amendment of or withdrawal from the medical list), in paragraph (5) from “Where a Health Authority” to “and the Medical Practices Committee grants such variation,” substitute “Where the Health Authority grants an application for the variation of a condition imposed pursuant to regulation 13(1)(b),”.

Amendment of Part III of the principal Regulations

6.  Omit regulations 10 (Medical Practices Committee—appointment of members and tenure of office) and 11 (references and reports to the Medical Practices Committee by a Health Authority).

7.  For regulation 12 (decisions of the Medical Practices Committee) substitute—

“Consideration of vacancies by Health Authorities

12.— (1) A Health Authority may consider at any time whether there is, or will be, a vacancy for a doctor to provide general medical services in their area.

(2) A Health Authority must consider whether there is, or will be, a vacancy for a doctor in their area if—

(a) it has been asked to do so by a doctor who provides general medical services in their area; or

(b) a doctor has died, or has withdrawn from, or been removed from, the Health Authority’s medical list.

(3) Where paragraph (2) applies and where a doctor’s prospective patients are situated in the area of more than one Health Authority, any of those Health Authorities may—

(a) elect to consider separately whether there is a vacancy for a doctor in respect of the prospective patients residing in their area; or

(b) agree to deal jointly with one or more other Health Authorities with prospective patients residing in their areas.

(4) In a case falling within paragraph (3)(b), the Health Authority in whose area reside the largest number of prospective patients shall decide whether to declare a vacancy, and, if it does so, it shall proceed in accordance with regulation 13.

(5) If a Health Authority is considering whether or not there is, or will be, a vacancy, the Health Authority shall before reaching a decision—

(a) consider the matters set out in Part I of Schedule 3;

(b) obtain from any other Health Authority in whose area prospective patients reside, such information as it thinks necessary.

(6) In reaching their decision a Health Authority shall, in particular, take account of—

(a) persons in their area performing personal medical services;

(b) any relevant financial considerations;

(c) the effect of creating a vacancy on any other Health Authority or Health Board in whose area prospective patients reside;

(d) any services outside general medical services and personal medical services already provided by doctors in their area.”.

8.—(1) Regulation 13 (declaration of vacancies) shall be amended in accordance with the following paragraphs.

(2) In paragraph (1) for “If the Medical Practices Committee” to “in a locality” substitute “If a Health Authority decides that the number of doctors undertaking to provide general medical services in the area”.

(3) For paragraph (1)(c) substitute—

“(c) may impose the condition that any doctor who is to fill a particular vacancy may provide general medical services only in such part of the area as the Health Authority may specify.”.

(4) In paragraph (2)(e)(ii) from “as shall have been specified in” to the end, substitute “as the Health Authority may specify.”.

(5) Omit paragraphs (3) and (4).

(6) After paragraph (4) add—

“(5) In a case to which regulation 12(3)(b) applies, before deciding which of the conditions set out in paragraph (2) it is appropriate to specify, the Health Authority declaring the vacancy shall consult any Health Authority in whose area prospective patients reside.

(6) When a Health Authority declares a vacancy to which regulation 18A or 18B applies, the vacancy will automatically lapse by effluxion of time after a period of 12 months beginning with the date of the declaration of the vacancy.

(7) When a Health Authority declares a vacancy for a sole practitioner, it shall advertise the vacancy within three months of the declaration of the vacancy or such further period as may be agreed by the Secretary of State.

(8) The Health Authority shall notify their decision in writing, giving reasons, to—

(a) the Local Medical Committee;

(b) any doctor who made a request under regulation 12(2)(a);

(c) any Health Authority or Health Board in whose area prospective patients reside.

(9) In this Part of these Regulations, where the prospective patients of a doctor reside in the area of more than one Health Authority, or in the area of both a Health Authority and a Health Board, any reference to “area” shall be construed as a reference to those areas in which prospective patients reside.”.

9.  Omit regulation 14 (report by Health Authority to Medical Practices Committee).

10.—(1) For regulation 15 (variation and revocation of decisions of the Medical Practices Committee) substitute—

“Variation and revocation of decisions of Health Authorities

15.— (1) Subject to paragraph (2), the Health Authority which declared a vacancy may—

(a) except in cases where an additional doctor has already been nominated or approved pursuant to regulation 18A, 18B or 18C, revoke a decision made pursuant to regulation 13(1) to declare a vacancy for an additional doctor in the area;

(b) in the case of a condition imposed pursuant to regulation 13(1)(b) (or such a condition as varied pursuant to this regulation), vary the condition by imposing in relation to any doctor who fills or would fill that particular vacancy another condition set out in regulation 13(2);

(c) in the case of a condition imposed pursuant to regulation 13(1)(c) (or such a condition as varied pursuant to this regulation), revoke the condition or vary it by specifying such other part of the area in which the doctor is to be excluded from providing general medical services as the Health Authority considers appropriate; or

(d) refuse to vary or revoke the decision in question.

(2) The Health Authority may not vary or revoke any decision referred to in paragraph (1)(b) or (c) without the written consent of any doctor to whom the existing condition applies.

(3) Before making a decision to vary or revoke a decision under this regulation, the Health Authority shall consult—

(a) the Local Medical Committee for its area;

(b) any Health Authority (or where regulation 18J applies, any Health Board) in whose area prospective patients reside.

(4) In cases where the Health Authority has, at the request or with the consent of a particular doctor, considered whether to vary a condition imposed pursuant to regulation 13(1)(b) or vary or revoke a condition imposed pursuant to regulation 13(1)(c) then the Health Authority shall give to that doctor a written statement of the reasons for its decision.”.

11.  For regulation 16 (effect of variation or revocation) substitute—

“16.   A decision of a Health Authority under regulation 13 or 15 has effect until it is varied or revoked, or expires by effluxion of time pursuant to regulation 13(6).”.

12.—(1) Regulation 17 (decision by Health Authority as to type of vacancy) shall be amended in accordance with the following paragraphs.

(2) For paragraph (1) substitute—

“(1) This regulation applies where a Health Authority decides that there is a vacancy for an additional doctor in the area.”.

(3) In paragraphs (2) and (3) for “If the Health Authority made a reference pursuant to regulation 11(1)” in each place where those words occur substitute “Where the Health Authority considered in accordance with regulation 12(2)(a) whether to declare a vacancy”.

(4) For paragraph (5) substitute—

“(5) In making their decision the Health Authority must—

(a) in a case to which regulation 12(3)(b) applies, consult any Health Authority in whose area the prospective patients reside; and

(b) take account, in particular, of the needs of the patients in the area.”.

13.  In regulation 18 (consultation with Local Medical Committee)—

(a) for sub-paragraphs (a) to (c) substitute—

“(a) declares a vacancy under regulation 13(1)(a),

(b) imposes conditions on a doctor under regulation 13(1)(b),

(c) decides under regulation 15 to vary or revoke a decision,”;

(b) after sub-paragraph (f), for “where regulation 11(2)(a)” substitute “where regulation 12(1)”.

14.  In regulation 18A(4) (particular partnership vacancies), after “agreed” add “(after consultation with any other Health Authority in whose area prospective patients reside).”.

15.—(1) Regulation 18B (general partnership vacancies) shall be amended in accordance with the following paragraphs.

(2) In paragraph (2) for “in the locality” in each place where those words occur substitute “in the area”;

(3) After paragraph (2) insert—

“(2A) Before setting the criteria referred to in paragraph (2)(a), the Health Authority must consult any other Health Authority in whose area prospective patients reside.”.

(4) In paragraph (7), after “agreed between the Health Authority” insert “(after consultation with any other Health Authority in whose area prospective patients reside)”.

16.—(1) Regulation 18C (vacancies for sole practitioners) shall be amended in accordance with the following paragraphs.

(2) In paragraph (6) omit “to the Secretary of State”.

(3) In paragraph (7)—

(a) for “regulation 12(4)(d)” substitute “regulation 13(7)”;

(b) for “must make a further reference” to the end, substitute “must consider again in accordance with regulation 12 whether there is, or will be, a vacancy in the area.”.

(4) For paragraph (8) substitute—

“(8) No vacancy may be re-advertised until the expiry of the period for appeal, or, if an appeal is lodged under regulation 18G, until that appeal is dismissed.”.

17.—(1) Regulation 18D (advertisement of vacancies for sole practitioners) shall be amended in accordance with the following paragraphs.

(2) For paragraph (1)(a) substitute—

“(a) the Health Authority has declared a vacancy, pursuant to regulation 13(1)(a), for an additional doctor in the area; and”.

(3) In paragraph (2) for “within such period as the Medical Practices Committee has specified pursuant to regulation 12(4)(d),” substitute “within the period specified in regulation 13(7),”.

(4) In paragraph (3)—

(a) in sub-paragraph (b) for “by the Medical Practices Committee” substitute “by the Health Authority”;

(b) for “the locality” substitute “the area”.

(5) In paragraph (6) for “the locality” substitute “the area, and shall be set after consultation with any other Health Authority in whose area prospective patients reside”.

18.  In regulation 18E (criteria for approval and nomination), in paragraph (3) omit “to the Secretary of State”.

19.—(1) Regulation 18F (entry on to medical list) shall be amended in accordance with the following paragraphs.

(2) In paragraph (1), omit “, and shall inform the Medical Practices Committee that it has done so.”.

(3) After paragraph (1) insert—

“(2A) The other Authorities are those whose areas include any part of the area in respect of which the vacancy was declared or, where the Health Authority has imposed a condition pursuant to regulation 13(1)(c), those whose areas include any part of the specified area.”(2).

(4) In paragraph (3) omit “to the Secretary of State”.

20.  In regulation 18G (appeal to the Secretary of State)—

(a) in paragraphs (1) and (3)(a) for “the Secretary of State” in each place those words occur, substitute “the FHSAA”;

(b) omit paragraphs (4) and (5) and (7) to (14).

21.  Omit regulations 18H (cases not requiring a reference to the Medical Practices Committee) and 18I (procedure in cases to which regulation 18H applies).

22.  For regulation 18J (cross-border vacancies) substitute—

“Cross-border vacancies

18J.— (1) This regulation applies where—

(a) a Health Authority is considering under regulation 12(1) or (2) whether there is, or will be, a vacancy; and

(b) a doctor’s prospective patients are situated in the area of one or more Health Authorities in England and of one or more Health Boards in Scotland.

(2) A Health Authority may elect to consider separately whether there is a vacancy in respect of prospective patients residing in their area.

(3) Where two or more Health Authorities agree to deal jointly with prospective patients residing in their areas, the Health Authority in whose area reside the largest number of the prospective patients of the additional doctor shall decide whether there is a vacancy and deal with it in accordance with the provisions contained in this Part of these Regulations.

(4) However, if one or more Health Authorities and one or more Health Boards agree to deal jointly with prospective patients residing in their areas, and the largest number of those prospective patients reside in the area of one of the Health Authorities, it shall be that Health Authority which shall decide whether there is a vacancy and deal with it in accordance with the provisions contained in this Part of these Regulations.

(5) Any Health Authority in whose area will reside any patient who is expected to be on the doctor’s list of patients (other than the Health Authority which is responsible for making the decision as to whether there is a vacancy) shall provide whatever information the Health Authority making the decision requires.

(6) Before—

(a) declaring a vacancy under regulation 13(1)(a);

(b) imposing conditions on a doctor under regulation 13(1)(b);

(c) making a decision as to whether an additional doctor should be a member of a partnership or a sole practitioner pursuant to regulation 17(4);

(d) setting or agreeing criteria pursuant to regulation 18D(5);

(e) nominating or approving an additional or replacement doctor pursuant to regulation 18A, 18B or 18C,

the Health Authority must consult the Local Medical Committee and any other Health Authority or Health Board in whose area reside individuals who are, or are expected to be, on the doctor’s list of patients.

(7) Where, under any provision of Regulations made under section 19B(3)(c) of the National Health Service (Scotland) Act 1978(3) corresponding to this regulation, a Health Board has nominated or approved an additional doctor in respect of prospective patients some of whom live in the area of a Health Authority, that Health Authority shall enter the name of the additional doctor in their medical list, subject to the following being met—

(a) any requirement as to consultation in the same terms as paragraph (6); and

(b) the criteria set out in regulation 18E(1).”

23.—(1) Regulation 18K (practice vacancies where patients are subject to pilot scheme proposals) shall be amended in accordance with the following paragraphs.

(2) In paragraph (1)—

(a) for sub-paragraph (a) substitute—

“(a) a Health Authority is considering under regulation 12(1) or (2) whether to declare a vacancy, or has declared a vacancy pursuant to regulation 13(1)(a); and”;

(b) for sub-paragraph (d) substitute—

“(d) either—

(i) the Health Authority is considering under regulation 12(1) or (2) whether to declare a vacancy but has not yet reached a decision, or

(ii) the Health Authority has declared a vacancy for an additional doctor in the area but the Health Authority has not yet nominated or approved a doctor pursuant to regulation 18A, 18B or 18C.”.

(3) For paragraph (2) substitute—

“(2) In a case referred to in paragraph (1), without prejudice to any steps that may already have been taken, a Health Authority shall not—

(a) consider under regulation 12(1) or (2) whether to declare a vacancy;

(b) declare a vacancy pursuant to regulation 13(1)(a);

(c) decide whether an additional doctor should be a member of a partnership or a sole practitioner pursuant to regulation 17(4);

(d) nominate or approve an additional doctor pursuant to regulation 18A, 18B or 18C; or

(e) give notice or further notice of the vacancy in accordance with regulation 18D,

until such time as one of the events set out in paragraph (3) has occurred.”.

(4) Omit paragraph (4).

24.  For Regulation 18L (transitional provision) substitute—

“Transitional provisions

18L.— (1) Any decision of the Medical Practices Committee taken before 1st April 2002 shall on or after that date have effect as though the decision had been made by the Health Authority which made the reference to the Medical Practices Committee, or the Health Authority which by virtue of article 7 of the Health Authorities (Establishment and Abolition) (England) Order 2002(4) (“the 2002 Order”) is deemed to have made the reference.

(2) Any condition of practice imposed before 1st April 2002 by the Medical Practices Committee under regulation 13(1)(b) or (1)(c), or such a condition as varied by the Medical Practices Committee pursuant to regulation 15(1), as then in force, shall on or after that date have effect as though the condition had been imposed by the Health Authority which by virtue of article 7 of the 2002 Order is deemed to have made the reference.

(3) Subject to paragraph (4), where before 1st April 2002—

(a) a reference had been made to the Medical Practices Committee under regulation 11(1) as then in force, but the Medical Practices Committee had not made a decision by that date; or

(b) an application had been made to the Medical Practices Committee under regulation 15 as then in force, but the Medical Practices Committee had not determined the application by that date,

the decision, or as the case may be, the determination shall be made in accordance with these Regulations by the Health Authority which made the reference or application or which by virtue of article 7 of the 2002 Order is deemed to have made the reference or application.

(4) Where the reference to the Medical Practices Committee was made at the request of a doctor providing general medical services in the area, that doctor may, on or after the 1st April 2002, choose to withdraw the request and make a new request for consideration of the vacancy instead.”

Amendment of regulation 37

25.  In regulation 37 (publication of particulars), in paragraph (3)(a) omit “the Medical Practices Committee,”.

Amendment of regulation 40

26.  In regulation 40 (certificate that transaction does not involve sale of goodwill), for “the Medical Practices Committee” substitute “the Secretary of State”.

Amendment of Schedule 2

27.—(1) Schedule 2 (terms of service) shall be amended in accordance with the following provisions.

(2) In paragraph 24(3) for “to the Medical Practices Committee” substitute “to the Secretary of State”.

(3) In paragraph 24(4)—

(a) for “the Medical Practices Committee” in each place where those words occur substitute “the Secretary of State”;

(b) for “that Committee” substitute “the Secretary of State”.

(4) In paragraph 29(8)(b) for “pursuant to section 33(4)(b) or (5) of the Act” and in paragraph 29A(3)(b) for “pursuant to section 33(4)(b) of the Act” substitute “under regulation 13(1)(c).”.

(5) In paragraph 32—

(a) in paragraph (1), for “the Medical Practices Committee” in each place where those words occur substitute “the Secretary of State”;

(b) in paragraph (2)—

(i) for “regulation 18A, 18B, 18C or 18I,” substitute “regulation 18A, 18B or 18C”,

(ii) for “the Secretary of State” in each place where those words occur substitute “the FHSAA”.

(6) In paragraph 33(1) for “the Medical Practices Committee” substitute “the Secretary of State”.

(7) In paragraph 34 (practice area), for sub-paragraph (2) substitute—

“(2) A doctor shall not, contrary to any condition imposed by the Health Authority, or on appeal the Secretary of State, under regulation 13(1)(c), open practice premises in any area or part of an area where, at the time of his application to open such premises, the Health Authority 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.”.

Amendment of Schedule 3

28.—(1) Schedule 3 shall be amended in accordance with the following provisions.

(2) For the heading to Part I (information to be included in a report by a Health Authority when making a reference to the Medical Practices Committee) substitute—

“Information to be considered by a Health Authority when deciding whether or not to declare a vacancy”.

(3) Omit paragraphs 9 and 10.

(4) For the heading to Part IB (additional information to be included where the reference is being made to the Medical Practices Committee on the death of a doctor, or the withdrawal or removal of a doctor from a medical list) substitute—

“B.   Additional information to be considered where the Health Authority is deciding whether or not to declare a vacancy on the death of a doctor, or on the withdrawal or removal of a doctor from a medical list”.

(5) In paragraph 13 for “If the Medical Practices Committee so requests,” substitute “Where the Health Authority considers it necessary,”.

(6) Omit Part II (information to be included in a report by a Health Authority to the Medical Practices Committee concerning adequacy of services).

Amendment of Schedule 7

29.  In Schedule 7 (form of certificate to be issued by Medical Practices Committee under paragraph 1(3) of Schedule 10 to the National Health Service Act 1977)—

(a) for the heading substitute “Form of Certificate to be issued by the Secretary of State under paragraph 1(3) of Schedule 10 to the National Health Service Act 1977”;

(b) for “the Medical Practices Committee” in each place where those words occur substitute “the Secretary of State”;

(c) for “Signature of the chairman or other member authorised by the Medical Practices Committee.” substitute “Signed by authority of the Secretary of State for Health.”.

Amendment of Schedule 8

30.  In Schedule 8 (doctors' hours)—

(a) in Part I (information to be included with any application under paragraph 29 of Schedule 2), for paragraph 8 substitute—

“8.   The terms of any condition imposed by the Health Authority under regulation 13(1)(c).”;

(b) in Part IV (illustrative list of health-related activities), in the last entry omit “or the Medical Practices Committee”.

Further amendments of Schedule 2 to the principal Regulations

31.—(1) In the principal Regulations, Schedule 2 (terms of service) shall be amended in accordance with the following paragraphs.

(2) In paragraph 23A(1) (assistants and deputies) for “before 28th February 2002.” substitute “before 31st March 2002.”.

(3) After paragraph 50A (NCAA assessment), insert the following paragraph—

“Appraisal Scheme

50B.   A doctor shall participate in the appraisal scheme provided by the Health Authority.”.

Minor amendments of the principal Regulations

32.  The principal Regulations shall be amended in accordance with the provisions of the Schedule.

Signed by the authority of the Secretary of State for Health

John Hutton

Minister of State,

Department of Health

8th March 2002