The National Health Service (General Ophthalmic Services etc.) Amendment Regulations 2006

Amendment of regulation 13 of the Supplementary List Regulations

5.  At the end of regulation 13 (suspension) of the National Health Service (General Ophthalmic Services Supplementary List) and (General Ophthalmic Services Amendment and Consequential Amendments) Regulations 2005(1) add—

“(18) If a payment is made pursuant to a determination under paragraph (17), but the payee was not entitled to receive all or any part of it, if the amount to which he was not entitled has not been recovered by other means, it may be recovered as a civil debt.

(19) If an ophthalmic medical practitioner or optician is dissatisfied with a decision of a Primary Care Trust (“the original decision”)—

(a) to refuse to make a payment to, or in respect of, him pursuant to a determination under paragraph (17);

(b) to make a payment to, or in respect of, him pursuant to a determination under paragraph (17), but at a lower level than the level to which he considers to be correct; or

(c) in respect of recovery of what the Primary Care Trust considers to be an overpayment,

he may ask the Primary Care Trust in writing to review the original decision and, if he does so, the Primary Care Trust shall reconsider that decision, and once it has done so, it must notify the ophthalmic medical practitioner or optician of the decision that is the outcome of its reconsideration of its original decision (“the reconsidered decision”), and give him notice of the reasons for its reconsidered decision.

(20) If the ophthalmic medical practitioner or optician remains dissatisfied (whether on the same or different grounds), he may appeal to the Secretary of State by giving him a notice of appeal within a period of 28 days beginning on the day that the Primary Care Trust notified him of the reconsidered decision.

(21) A notice of appeal under paragraph (20) shall include—

(a) the names and addresses of the parties to the disputed decision;

(b) a copy of the reconsidered decision; and

(c) a brief statement of the grounds for appeal.

(22) The Secretary of State shall then send a written request to the parties to make, in writing and within a period specified by him, any representations they may wish to make about the matter (and the request to the Primary Care Trust shall include a copy of the ophthalmic medical practitioner or optician’s brief statement of the grounds for appeal).

(23) Once the period specified pursuant to paragraph (22) has elapsed, the Secretary of State shall—

(a) give a copy of the representations received from a party to the other party; and

(b) request in writing a party to whom a copy of representations is given to make within a period specified by him any written observations which he or it wishes to make on those representations.

(24) Once the period specified pursuant to paragraph (23)(b) has elapsed, the Secretary of State shall, as soon as is reasonably practicable, having taken into account any such representations or observations as are referred to in paragraphs (22) and (23) (if submitted within the specified periods) and such other evidence as he sees fit to consider–—

(a) determine the appeal, and shall give notice of the determination (including a record of the reasons for it) to both parties; and

(b) give the Primary Care Trust such directions in writing, if any, on the matter as he thinks fit.”.

(1)

S.I. 2005/480.