45.—(1) A contractor must not sub-contract all or part of its duty to provide out of hours services under the contract to a person other than those specified in sub-paragraph (2) without the prior written approval of the Board.
(2) The persons specified in this sub-paragraph are—
(a)a person who holds a general medical services contract with the Board which includes out of hours services;
(b)a section 92 provider who is required to provide the equivalent of essential services to its patients during all or part of the out of hours period;
(c)a health care professional, not falling within paragraph (a) or (b), who is to provide the out of hours services personally under a contract for services; or
(d)a group of medical practitioners, whether in partnership or not, who provide out of hours services for each other under informal rota agreements.
(3) The requirement in sub-paragraph (1) to obtain prior written approval does not apply in any case where a contractor sub-contracts all or part of its duty to provide out of hours services under the contract on a short term or occasional basis.
(4) An application for approval under sub-paragraph (1) may be made by the contractor in writing to the Board and must state—
(a)the name and address of the proposed sub-contractor;
(b)the address of any premises to be used for the provision of services under the sub-contract;
(c)the duration of the proposed sub-contract;
(d)the services to be covered by the sub-contract; and
(e)the manner in which the sub-contractor proposes to meet the contractor’s obligations under the contract in respect of the services to be covered by the sub-contract.
(5) The Board may request such further information relating to arrangements under the proposed sub-contract as appears to it to be reasonable before the end of the period of seven days beginning with the date on which the Board received the application under sub-paragraph (4).
(6) Where the Board receives an application which meets the requirements specified in sub-paragraph (4), or receives any further information requested under sub-paragraph (5) in relation to an application, the Board must, before the end of the period of 28 days beginning with the date on which it received the application or that information (whichever is the latest)—
(a)approve the application;
(b)approve the application subject to conditions; or
(c)refuse the application.
(7) The Board must not refuse the application if it is satisfied that the arrangements covered by the proposed sub-contract would, in respect of the services to be provided, enable the contractor to satisfactorily meet its obligations under the contract and would not—
(a)put the safety of the contractor’s patients at serious risk; or
(b)put the Board at risk of material financial loss.
(8) The Board must give notice in writing to the contractor of its decision on the application and, where it refuses an application, it must include in the notice a statement of the reasons for its refusal.
(9) Where the Board approves an application under this paragraph, the parties to the contract are deemed to have agreed a variation of the contract which has the effect of adding to the list of practice premises, for the purposes of the provision of services in accordance with that application, any premises the address of which was notified to the Board under sub-paragraph (4)(b) and, in these circumstances, paragraph 57(1) of Schedule 3 does not apply.
(10) Sub-paragraphs (1) to (9) also apply in relation to any renewal or material variation of a sub-contract in relation to out of hours services.
(11) A sub-contract entered into by a contractor must prohibit the sub-contractor from sub-contracting the out of hours services that it has agreed with the contractor to provide under the sub-contract.