The General Medical Services and Personal Medical Services Transitional and Consequential Provisions Order 2004

Appeals to the Secretary of State against determinations of Primary Care Trusts (regulations 9, 10 and 11 of the Service Committees Regulations)

99.—(1) Where—

(a) a doctor has appealed against a determination of a Primary Care Trust in accordance with regulation 9 before the relevant date, but that appeal has not been finally determined before that date; or

(b) in respect of a determination made by a Primary Care Trust in accordance with regulation 8 before the relevant date, the time limit specified in regulation 9(2) for appealing that determination has not expired before the relevant date, and the doctor serves a notice of appeal on or after the relevant date but within the time limit specified in regulation 9(2),

that appeal shall be determined pursuant to regulations 9, 10 and 11, as if the amendments to those regulations and Schedule 5 had not taken effect.

(2) Where an appropriate Primary Care Trust has made a determination in respect of a doctor on or after the relevant date pursuant to this Part—

(a) the doctor shall be entitled to appeal against that determination in accordance with regulation 9; and

(b) that appeal shall be determined pursuant to regulations 9, 10 and 11,

as if the amendments to those regulations and to Schedule 5 had not taken effect.

(3) Where, on or after the relevant date, the Secretary of State is determining pursuant to regulation 9, 10 or 11 (as the case may be) what (if any) action to take in respect of a doctor, he shall make a determination pursuant to those regulations as if the amendments to those regulations and to Schedule 5 had not taken effect and that determination shall have effect in accordance with this article.

(4) If, in accordance with paragraph (3), the Secretary of State determines pursuant to—

(a) regulation 8(3), that he would have considered it appropriate to impose a special limit on the number of persons for whom a doctor may undertake to provide treatment;

(b) pursuant to regulation 9(3)(d), that there has been an overpayment and, if so, what amount;

(c) pursuant to regulation 8(5)(a) and 9(3) or 11, that an amount shall be recovered from the doctor; or

(d) pursuant to regulation 8(5)(c), that he would have warned the practitioner to comply more closely with his terms of service in future, if those terms of service were still applicable,

he shall, in addition to the persons specified in regulation 10(14), notify the Primary Care Trusts specified in paragraph (5).

(5) The Secretary of State shall, pursuant to paragraph (4)(a) to (d), notify the contracting PCT and the Performers List PCT (if any) of his determination if those Primary Care Trusts are different to the Primary Care Trust referred to in regulation 10(14).

(6) Where, pursuant to regulation 8(5)(a) and 9(3) or 11, the Secretary of State has determined that an amount shall be recovered from a doctor he shall direct the appropriate Primary Care Trust, to recover that amount from the doctor and that amount shall be a debt owed to that appropriate Primary Care Trust.

(7) Where, pursuant to paragraph (5), the Secretary of State has notified the contracting PCT that he has taken any of the decisions specified in paragraph (4)(a) to (d), whether or not the contracting PCT is also the appropriate Primary Care Trust, paragraph (8) shall apply without prejudice to any other right the contracting PCT may have to take action against the relevant contractor pursuant to any term of the general medical services contract or default contract.

(8) Where this paragraph applies, the contracting PCT may, in relation to a relevant contractor, take into account the determination of the Secretary of State if it is considering, pursuant to a term of the general medical services contract that gives effect to paragraph 115(7) of Schedule 6 to the 2004 Regulations, or an equivalent term in the default contract, whether the cumulative effect of breaches under that contract is such that to allow the contract to continue would be prejudicial to the efficiency of the services provided under that contract.

(9) The contracting PCT shall not, pursuant to paragraph (8), take into account any notification received that relates to a determination that was made by the Secretary of State that occurred more than 6 years prior to the date upon which the contracting PCT is considering the matter pursuant to paragraph (8).

(10) Where a Performers List PCT has received notification from the Secretary of State pursuant to paragraph (4) or (5), whether or not the Performers List PCT is also the appropriate Primary Care Trust, it shall consider what (if any) action it should take in respect of that doctor pursuant to its powers under the Performers Lists Regulations.