In this Schedule—

• “opt out notice” means a notice given under sub-paragraph (5) to permanently opt out or temporarily opt out of the provision of the additional service;

• “permanent opt out” in relation to the provision of an additional service that is funded through the global sum, means the termination of the obligation under the contract for the contractor to provide that service; and “permanently opt out” shall be construed accordingly;

• “permanent opt out notice” means an opt out notice to permanently opt out;

• “preliminary opt out notice” means a notice given under sub-paragraph (2) that a contractor wishes to temporarily opt out or permanently opt out of the provision of an additional service;

• “temporary opt out” in relation to the provision of an additional service that is funded through the global sum, means the suspension of the obligation under the contract for the contractor to provide that service for a period of more than six months and less than twelve months and includes an extension of a temporary opt out and “temporarily opt out” and “temporarily opted out” shall be construed accordingly; and

• “temporary opt out notice” means an opt out notice to temporarily opt out.

A contractor who wishes to permanently or temporarily opt out shall give to the relevant Primary Care Trust in writing a preliminary opt out notice which shall state the reasons for wishing to opt out.

As soon as is reasonably practicable and in any event within the period of 7 days beginning with the receipt of the preliminary opt out notice by the Primary Care Trust, the Primary Care Trust shall enter into discussions with the contractor concerning the support which the Primary Care Trust may give the contractor, or concerning other changes which the Primary Care Trust or the contractor may make, which would enable the contractor to continue to provide the additional service and the Primary Care Trust and the contractor shall use reasonable endeavours to achieve this aim.

The discussions mentioned in sub-paragraph (3) shall be completed within the period of 10 days beginning with the date of the receipt of the preliminary opt out notice by the Primary Care Trust or as soon as reasonably practicable thereafter.

Subject to sub-paragraph (9), if following the discussions mentioned in sub-paragraph (3), the contractor still wishes to opt out of the provision of the additional service, it shall send an opt out notice to the Primary Care Trust.

Where a contractor has given two previous temporary opt out notices within the period of three years ending with the date of the service of the latest opt out notice (whether or not the same additional service is concerned), the latest opt out notice shall be treated as a permanent opt out notice (even if the opt out notice says that it wishes to temporarily opt out).

Paragraph 2 applies following the giving of a temporary opt out notice and paragraph 3 applies following the giving of a permanent opt out notice or a temporary opt out notice which pursuant to sub-paragraph (7) is treated as a permanent opt out notice.

No temporary opt out notice may be served by a contractor prior to 1st April 2004.

The date specified by the Primary Care Trust for the commencement of the temporary opt out shall wherever reasonably practicable be the date requested by the contractor in its opt out notice.

Before determining the end date, the Primary Care Trust shall make reasonable efforts to reach agreement with the contractor.

Before the end date, a Primary Care Trust may, in exceptional circumstances and with the agreement of the contractor, notify the contractor in writing of a later date on which the temporary opt out is to come to an end, being a date no more than six months later than the end date.

Where a Primary Care Trust notifies the contractor under sub-paragraph (7) that a permanent opt out shall follow a temporary opt out, the permanent opt out shall take effect immediately after the end of the temporary opt out.

A contractor who has temporarily opted out may, at least three months prior to the end date, notify the relevant Primary Care Trust in writing that it wishes to permanently opt out of the additional service in question.

Where the contractor has notified the Primary Care Trust under sub-paragraph (9) that it wishes to permanently opt out, the temporary opt out shall be followed by a permanent opt out beginning on the day after the end date unless the Primary Care Trust refuses the contractor’s request to permanently opt out by giving a notice in writing to the contractor to this effect.

A Primary Care Trust may only give a notice under sub-paragraph (10) with the approval of the relevant Strategic Health Authority.

Where a Primary Care Trust seeks the approval of a Strategic Health Authority to a proposed decision to refuse a permanent opt out, it shall notify the contractor of having done so.

If the relevant Strategic Health Authority has not reached a decision as to whether or not to approve the Primary Care Trust’s proposed decision to refuse a permanent opt out before the end date, the contractor’s obligation to provide the additional service shall remain suspended until the date specified in sub-paragraph (5)(d)(ii) or (iii) (whichever is applicable).

Where after the end date the relevant Strategic Health Authority notifies the Primary Care Trust that it does not approve the Primary Care Trust’s proposed decision to refuse a permanent opt out, the Primary Care Trust shall notify the contractor in writing of this fact as soon as is reasonably practicable.

In this paragraph—

• “A day” is the day specified by the contractor in its permanent opt out notice to a Primary Care Trust for the commencement of the permanent opt out;

• “B day” is the day six months after the date of service of the permanent opt out notice; and

• “C day” is the day nine months after the date of service of the permanent opt out notice.

A Primary Care Trust may reject the opt out notice on the ground that the contractor is providing an additional service to patients other than its registered patients or enhanced services.

A contractor may not withdraw an opt out notice once it has been approved by the Primary Care Trust in accordance with sub-paragraph (2)(a) without the Primary Care Trust’s agreement.

If the Primary Care Trust approves the opt out notice under sub-paragraph (2)(a), it shall use its reasonable endeavours to make arrangements for the contractor’s registered patients to receive the additional service from an alternative provider from A day.

The contractor’s duty to provide the additional service shall terminate on A day unless the Primary Care Trust serves a notice under sub-paragraph (7) (extending A day to B day or C day).

Where in accordance with sub-paragraph (7)(a) the permanent opt out is to commence on B day and the Primary Care Trust, despite using its reasonable endeavours has failed to find an alternative provider to take on the provision of the additional service from that day, it shall notify the contractor in writing of this fact at least one month before B day, in which case the contractor shall continue to provide the additional service until C Day unless at least one month before C day it receives a notice from the Primary Care Trust under sub-paragraph (11) that it has applied to the relevant Strategic Health Authority under sub-paragraph (10) seeking the approval of the relevant Strategic Health Authority to a decision to refuse a permanent opt out or to postpone the commencement of a permanent opt out until after C day.

As soon as is reasonably practicable and in any event within 7 days of the Primary Care Trust serving a notice under sub-paragraph (8), the Primary Care Trust shall enter into discussions with the contractor concerning the support that the Primary Care Trust may give to the contractor or other changes which the Primary Care Trust or the contractor may make in relation to the provision of the additional service until C day.

As soon as practicable after making an application under sub-paragraph (10) to the Strategic Health Authority, the Primary Care Trust shall notify the contractor in writing that it has made such an application.

The relevant Strategic Health Authority shall notify the Primary Care Trust and the contractor in writing of its decision under sub-paragraph (12) or (13) as soon as is practicable, including reasons for its decision.

Where a Primary Care Trust notifies a contractor under sub-paragraph (15), the contractor may not serve a preliminary opt out notice in respect of that additional service for a period of 12 months beginning with the date of service of the Primary Care Trust’s notice under sub-paragraph (15) unless there has been a change in the circumstances of the contractor which affects its ability to deliver services under the contract.

Where the Strategic Health Authority rejects the Primary Care Trust’s application under sub-paragraph (12)(c) or (13)(c), the Primary Care Trust shall notify the contractor in writing that there shall be a permanent opt out and the permanent opt out shall commence on C day or 28 days after the date of service of the Primary Care Trust’s notice, whichever is the later.

If the relevant Strategic Health Authority has not reached a decision on the Primary Care Trust’s application under sub-paragraph (10) before C day, the contractor’s obligation to provide the additional service shall continue until a notice is served on it by the Primary Care Trust under sub-paragraph (17) or (18).

Nothing in sub-paragraphs (1) to (19) above shall prevent the contractor and the Primary Care Trust from agreeing a different date for the termination of the contractor’s duty under the contract to provide the additional service and accordingly, varying the contract in accordance with paragraph 104(1) of Schedule 6.

This paragraph applies where a contractor wishes to serve or serves an out of hours opt out notice after 30th September 2004.

A contractor which wishes to terminate its obligation to provide out of hours services which was included in the contract pursuant to regulation 30 shall notify the relevant Primary Care Trust in writing to that effect (“an out of hours opt out notice”).

An out of hours opt out notice shall specify the date from which the contractor would like the opt out to take effect, which must be either three or six months after the date of service of the out of hours opt out notice.

As soon as is reasonably practicable and in any event within 28 days of receiving the out of hours opt out notice, the Primary Care Trust shall approve the notice and specify in accordance with sub-paragraph (6) the date on which the out of hours opt out is to commence (“OOH day”).

The Primary Care Trust shall notify the contractor of its decision as soon as possible.

The date specified in sub-paragraph (4) shall be the date specified in the out of hours opt out notice.

A contractor may not withdraw an out of hours opt out notice once it has been approved by the Primary Care Trust under sub-paragraph (4) without the Primary Care Trust’s agreement.

Following receipt of the out of hours opt out notice, the Primary Care Trust must use its reasonable endeavours to make arrangements for the contractor’s registered patients to receive the out of hours services from an alternative provider from OOH day.

Sub-paragraphs (6) to (21) of paragraph 3 shall apply to an out of hours opt out as they apply to a permanent opt out and as if the reference to “A day” was a reference to “OOH day” and the reference in paragraph 3(16) to a “preliminary opt out notice” was a reference to “an out of hours opt out notice”.

This paragraph shall apply where a contractor wishes to serve or serves an out of hours opt out notice before 1st October 2004.

In this paragraph—

• “OOH day” is the day specified by the Primary Care Trust for the commencement of the out of hours opt out in its decision under sub-paragraph (5);

• “OOHB day” is the day six months after the date of service of the out of hours opt out notice; and

• “OOHC day” is the day specified by the Primary Care Trust in its decision under sub-paragraph (11) or (13) (which must be nine months after the date of service of the out of hours opt out notice or before 2nd January 2005).

A contractor which wishes to terminate its obligation to provide out of hours services which was included in the contract pursuant to regulation 30 shall notify the relevant Primary Care Trust in writing to that effect (“an out of hours opt out notice”).

An out of hours opt out notice shall state the date on which the contractor would like the opt out to take effect, which must be either three or six months after the date of service of the out of hours opt out notice.

As soon as is reasonably practicable and in any event within 28 days of receiving the out of hours opt out notice, the Primary Care Trust shall approve the notice and specify in accordance with sub-paragraphs (6) and (7) the date on which the out of hours opt out is to commence (OOH day) and the Primary Care Trust shall notify the contractor in writing of its decision as soon as possible, including reasons for its decision.

A Primary Care Trust may not specify under sub-paragraph (5) a date earlier than the date specified in the out of hours opt out notice.

A contractor may not withdraw an out of hours opt out notice once it has been approved by a Primary Care Trust under sub-paragraph (5) without the Primary Care Trust’s agreement.

Following receipt of the out of hours opt out notice, the Primary Care Trust must use its reasonable endeavours to make arrangements for the contractor’s registered patients to receive out of hours services from an alternative provider from OOH day.

OOHC day shall be any day before 2nd January 2005 or the day nine months after the service of the out of hours opt out notice.

Where in accordance with sub-paragraph (11)(a) the out of hours opt out is to commence on OOHB day and the Primary Care Trust, despite using its reasonable endeavours has failed to find an alternative provider to take on the provision of the out of hours services from that day, it shall notify the contractor in writing of this fact at least one month before OOHB day, in which case the contractor shall continue to provide the out of hours services until OOHC day (which shall be specified by the Primary Care Trust in accordance with sub-paragraph (12) and included in its notice to the contractor under this sub-paragraph) unless at least one month before OOHC day it receives a notice from the Primary Care Trust under sub-paragraph (16) that it has applied to the relevant Strategic Health Authority under sub-paragraph (14) seeking the approval of the relevant Strategic Health Authority to a decision to refuse an opt out or to postpone the commencement of an opt out until after OOHC day.

Where OOH day is 1st January 2005, and 1st January 2005 is nine months or more after the date of the out of hours opt out notice, an application under sub-paragraph (14) shall be made at least one month before OOH day.

As soon as practicable after making an application under sub-paragraph (14) to the Strategic Health Authority, the Primary Care Trust shall notify the contractor in writing that it has made such an application.

Sub-paragraphs (12) to (21) of paragraph 3 shall apply to an out of hours opt out as they apply to a permanent opt out and as if the reference to “C day” was a reference to OOHC day or OOH day where OOH day is 1st January 2005 and 1st January 2005 is nine months or more after the date of the out of hours opt out notice.

Prior to any opt out taking effect, the Primary Care Trust and the contractor shall discuss how to inform the contractor’s patients of the proposed opt out.

In this paragraph “opt out” means an out of hours opt out, a permanent opt out or a temporary opt out.