The National Health Service (General Medical Services Contracts) (Wales) Regulations 2004

PART 1 GENERAL

Citation, commencement and application

1.—(1) These Regulations may be cited as the National Health Service (General Medical Services Contracts) (Wales) Regulations 2004 and shall come into force on 1st March 2004.

(2) These Regulations apply in relation to Wales only.

Interpretation

2.—(1) In these Regulations —

the Act” means the National Health Service Act 1977;

the 1990 Act” means the National Health Service and Community Care Act 1990;

[F1“the 2010 Order” means the Postgraduate Medical Education and Training Order of Council 2010;]

Abolition of the Tribunal Regulations” means the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2001 M1;

Abolition of the Tribunal (Wales) Regulations” means the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2002 M2;

[F2“accredited course” means a course accredited by the Nursing and Midwifery Council;]

additional services” means one or more of —

(a)

cervical screening services,

(b)

contraceptive services,

(c)

vaccinations and immunisations,

(d)

childhood vaccinations and immunisations,

(e)

child health surveillance services,

(f)

maternity medical services, and

(g)

minor surgery;

adjudicator” means the Assembly or a person or persons appointed by the Assembly under section 4(5) of the 1990 Act or [F3paragraph 99(5)] of Schedule 6;

appliance” means an appliance which is included in a list for the time being approved by the Assembly for the purposes of section 41 of the Act;

approved medical practice” shall be construed in accordance with section 11(4) of the Medical Act 1983 M3;

Assembly” means the National Assembly for Wales;

assessment panel” means a committee or sub-committee of a Local Health Board (other than the Local Health Board which is a party to the contract in question) appointed to exercise functions under paragraphs 31 and 35 of Schedule 6;

bank holiday” means any day that is specified or proclaimed as a Bank holiday [F4in England and Wales] pursuant to section 1 of the Banking and Financial Dealings Act 1971 M4;

batch issue” means a form provided by a Local Health Board and issued by a prescriber at the same time as a repeatable prescription to enable a chemist to receive payment for the provision of repeat dispensing services which is in the format specified in Part 2 of Schedule 1, and which —

(a)

is generated by a computer and not signed by a prescriber,

(b)

relates to a particular repeatable prescription and contains the same dates as that prescription,

(c)

is issued as one of a sequence of forms, the number of which is equal to the number of occasions on which the drugs, medicines or appliances ordered on the repeatable prescription may be provided, and

(d)

specifies a number denoting its place in the sequence referred to in paragraph (c);

CCT” means Certificate of Completion of Training awarded under [F5section 34L(1) of the Medical Act 1983] F6...;

cervical screening services” means the services described in paragraph 2(2) of Schedule 2;

charity trustee” means one of the persons having the general control and management of a charity;

chemist” means —

(a)

a registered pharmacist,

(b)

a person lawfully conducting a retail pharmacy business in accordance with section 69 of the Medicines Act 1968 M5, or

(c)

a supplier of appliances,

who is included in the list of a Local Health Board or [F7the National Health Service Commissioning Board] under section 42 of the Act, or who provides local pharmaceutical services in accordance with LPS arrangements;

CHC” means a Community Health Council retained or established under section 20A of the Act M6;

child” means a person who has not attained the age of 16 years;

child health surveillance services” means the services described in paragraph 6(2) of Schedule 2;

childhood vaccinations and immunisations” means the services described in paragraph 5(2) of Schedule 2;

[F8clinical commissioning group” means a body established under section 14D of the National Health Service Act 2006;]

closed”, in relation to the contractor’s list of patients, means closed to applications for inclusion in the list of patients other than from immediate family members of registered patients;

contraceptive services” means the services described in paragraph 3(2) of Schedule 2;

contract” means, except where the context otherwise requires, a general medical services contract under section 28Q of the Act;

contractor’s list of patients” means the list prepared and maintained by the Local Health Board under paragraph 14 of Schedule 6;

core hours” means the period beginning at 8am and ending at 6.30pm on any day from Monday to Friday except Good Friday, Christmas Day or bank holidays;

dispensing services” means the provision of drugs, medicines or appliances that may be provided as pharmaceutical services by a medical practitioner in accordance with arrangements made under regulation 20 of the Pharmaceutical Regulations; M7

Drug Tariff” has the same meaning as in [F9regulation 41] of the Pharmaceutical Regulations;

enhanced services” are —

(a)

services other than essential services, additional services or out of hours services, or

(b)

essential services, additional services or out of hours services or an element of such a service that a contractor agrees under the contract to provide in accordance with specifications set out in a plan, which requires of the contractor an enhanced level of service provision compared to that which it needs generally to provide in relation to that service or element of service;

essential services” means the services required to be provided in accordance with regulation 15;

F10...M8

[F11general medical practitioner” means, unless the context otherwise requires, a medical practitioner whose name is included in the General Practitioner Register kept by the General Medical Council;]

F12...

global sum” has the same meaning as in the GMS Statement of Financial Entitlements;

GMS Statement of Financial Entitlements” means the directions given by the Assembly under section 28T of the Act M9 on 1st April 2004;

[F11GP Registrar” means a medical practitioner who is being trained in general practice by a general medical practitioner who is approved under section 34I of the Medical Act 1983 for the purpose of providing training under that section, whether as part of training leading to the award of a CCT or otherwise;]

F13...

(a)

(b)

Health and Social Services Board” means a Health and Social Services Board established under the Health and Personal Social Services (Northern Ireland) Order 1972 M10;

Health and Social Services Trust” means a Health and Social Services Trust established under Article 10(1) of the Health and Personal Social Services (Northern Ireland) Order 1991 M11;

Health Board” means a Health Board established under section 2 of the National Health Service ( Scotland) Act 1978 M12;

health care professional” has the same meaning as in section 28M of the Act and “health care profession” shall be construed accordingly;

health service body” has, unless the context otherwise requires, the meaning given to it in section 4(2) of the 1990 Act;

[F14“home oxygen order form” means a form provided by a Local Health Board and issued by a health care professional to authorise a person to supply home oxygen services to a patient requiring oxygen therapy at home;]

[F14“home oxygen services” means any of the following forms of oxygen therapy or supply—

(a)

ambulatory oxygen supply,

(b)

urgent supply,

(c)

hospital discharge supply,

(d)

long term oxygen therapy, and

(e)

short burst oxygen therapy;]

immediate family member” means —

(a)

a spouse [F15or civil partner],

(b)

a person (whether or not of the opposite sex) whose relationship with the registered patient has the characteristics of the relationship between husband and wife,

(c)

a parent or step-parent,

(d)

a son,

(e)

a daughter,

(f)

a child of whom the registered patient is —

(i)

the guardian, or

(ii)

the carer duly authorised by a local authority to whose care the child has been committed under the Children Act 1989 M13, or

(g)

a grandparent;

[F16“independent nurse prescriber” means a person —

(a)

who is either engaged or employed by the contractor or is a party to the contract,

(b)

who is registered in the Nursing and Midwifery Register, and

(c)

against whose name in that register is recorded an annotation or entry signifying that he or she is qualified to order drugs, medicines and appliances as a community practitioner nurse prescriber;]

licensing authority” shall be construed in accordance with section 6(3) of the Medicines Act 1968 M14;

licensing body” means any body that licenses or regulates any profession;

limited partnership” means a partnership registered in accordance with section 5 of the Limited Partnerships Act 1907 M15;

Local Health Board” means, unless the context otherwise requires, the Local Health Board which is a party, or prospective party, to the contract M16;

Local Medical Committee” means a committee recognised under section 45A of the Act;

local pharmaceutical services” has the same meaning as in regulation 2 of the National Health Service (Local Pharmaceutical Services and Pharmaceutical Services) Regulation 2002 M17.

maternity medical services” means the services described in paragraph 7(1) of Schedule 2;

medical card” means a card issued by a Local Health Board,F17... Health Authority, Health Board or Health and Social Services Board [F18or the National Health Service Commissioning Board] to a person for the purpose of enabling him to obtain, or establishing his title to receive, primary medical services;

F10...

(a)

(b)

medical performers list” means a list of medical practitioners prepared in accordance with regulations made under section 28X of the Act M18;

Medical Register” means the registers kept under section 2 of the Medical Act 1983 M19;

minor surgery” means the services described in paragraph 8(2) of Schedule 2;

F19...

national disqualification” means —

(a)

a decision made by the [F20First-tier Tribunal] under section 49N of the Act [F21or under regulations corresponding to that section made under section 28X(4) of the Act (persons performing primary medical and dental services)],

(b)

a decision under provisions in force in Scotland or Northern Ireland corresponding to section 49N of the Act, or

(c)

a decision by the NHS Tribunal which [F22was treated as a national disqualification by the Family Health Services Appeal Authority] by virtue of regulation 6(4)(b) of the Abolition of the Tribunal Regulations or regulation 6(4)(b) of the Abolition of the Tribunal (Wales) Regulations;

NHS contract” has the meaning assigned to it in section 4 of the 1990 Act;

the NHS dispute resolution procedure” means the procedure for resolution of disputes specified —

(a)

in paragraphs 99 and 100 of Schedule 6; or

(b)

in a case to which paragraph 36 of Schedule 6 applies, in that paragraph.

[F23NHSLA” means the National Health Service Litigation Authority established as a Special Health Authority by the National Health Service Litigation Authority (Establishment and Constitution) Order 1995;]

the NHS Tribunal” means the Tribunal constituted under section 46 of the Act M20 for England and Wales, and which, except for prescribed cases, had effect in relation to England only until 14th December 2001 and in relation to Wales only until 26th August 2002 M21;

normal hours” means those days and hours on which and the times at which services under the contract are normally made available and may be different for different services;

F24...

[F25“nurse independent prescriber” means a person —

(a)

who is either engaged or employed by the contractor or is a party to the contract,

(b)

whose name is registered in the Nursing and Midwifery Register, and

(c)

against whose name in that register is recorded an annotation or entry signifying that he or she is qualified to order drugs, medicines and appliances as—

(i)

a nurse independent prescriber, or

(ii)

a nurse independent/ supplementary prescriber, and

(d)

who, in respect of a person practising in Wales on or after 19 July 2010, has passed an accredited course to practise as a nurse independent prescriber;]

Nursing and Midwifery Register” means the register maintained by the Nursing and Midwifery Council under the Nursing and Midwifery Order 2001 M22;

open”, in relation to a contractor’s list of patients, means open to applications from patients in accordance with paragraph 15 of Schedule 6;

out of hours period” means —

(a)

the period beginning at 6.30pm on any day from Monday to Thursday and ending at 8am on the following day;

(b)

the period between 6.30pm on Friday and 8am on the following Monday, and

(c)

Good Friday, Christmas Day and bank holidays,

and “part” of an out of hours period means any part of any one or more of periods described in paragraphs (a) to (c);

out of hours services” means services required to be provided in all or part of the out of hours period which —

(a)

would be essential services if provided [F26by a contractor to its registered patients] in core hours, and

(b)

are included in the contract as additional services funded under the global sum;

parent” includes, in relation to any child, any adult who, in the opinion of the contractor, is for the time being discharging in respect of that child the obligations normally attaching to a parent in respect of his or her child;

patient” means —

(a)

a registered patient,

(b)

a temporary resident,

(c)

persons to whom the contractor is required to provide immediately necessary treatment under regulation 15(6) or (8) respectively,

(d)

any other person to whom the contractor has agreed to provide services under the contract,

(e)

any person for whom the contractor is responsible under regulation 31, and

(f)

any person for whom the contractor is responsible under arrangements made with another contractor in accordance with Schedule 7;

Pharmaceutical Regulations” means the [F27National Health Service (Pharmaceutical Services) (Wales) Regulations 2013];

[F2“pharmacist independent prescriber” means a person—

(a)

who is either engaged or employed by the contractor or is a party to the contract,

(b)

who is a pharmacist, and

(c)

against whose name is recorded in the relevant register an annotation signifying that he or she is qualified to order drugs, medicines and appliances as a pharmacist independent prescriber;”.]

[F28“physiotherapist independent prescriber” means a person—

(a)

who is either engaged or employed by the contractor or is a party to the contract,

(b)

who is a physiotherapist, and

(c)

against whose name is recorded in the relevant register an annotation signifying that he or she is qualified to order drugs, medicines and appliances as a physiotherapist independent prescriber;]

pilot scheme” means an agreement made under Part 1 of the National Health Service (Primary Care) Act 1997 M23;

[F28“podiatrist or chiropodist independent prescriber” means a person—

(a)

who is either engaged or employed by the contractor or is a party to the contract,

(b)

who is a podiatrist or chiropodist, and

(c)

against whose name is recorded in the relevant register an annotation signifying that he or she is qualified to order drugs, medicines and appliances as a podiatrist or chiropodist independent prescriber;]

F29...M24

practice” means the business operated by the contractor for the purpose of delivering services under the contract;

practice area” means the area referred to in regulation 18(1)(d);

practice leaflet” means a leaflet drawn up in accordance with paragraph 75 of Schedule 6;

practice premises” means an address specified in the contract as one at which services are to be provided under the contract;

prescriber” means —

(a)

a medical practitioner,

(b)

an independent nurse prescriber, F30...

(c)

a supplementary prescriber,

(d)

[F31a nurse independent prescriber, F32...

(e)

a pharmacist independent prescriber,]

(f)

[F33a physiotherapist independent prescriber, and

(g)

a podiatrist or chiropodist independent prescriber;]

who is either engaged or employed by the contractor or is a party to the contract;

prescription form” means a form provided by the Local Health Board and issued by a prescriber to enable a person to obtain pharmaceutical services or local pharmaceutical services and does not include a repeatable prescription;

prescription only medicine” means a medicine referred to in [F34regulation 5(3) (classification of medicinal products) of the Human Medicines Regulations 2012];

primary care list” means —

(a)

a list of persons performing primary medical or dental services prepared in accordance with regulations made under section 28X of the Act M25,

(b)

a list of persons undertaking to provide general medical services, general dental services, general ophthalmic services or, as the case may be, pharmaceutical services prepared in accordance with regulations made under sections 29, 36, 39, 42 or 43 of the Act,

(c)

a list of persons approved for the purposes of assisting in the provision of any services mentioned in paragraph (b) prepared in accordance with regulations made under section 43D of the Act M26,

(d)

a services list referred to in section 8ZA of the National Health Service (Primary Care) Act 1997 M27,

(e)

a list corresponding to a services list prepared by virtue of regulations made under section 41 of the Health and Social Care Act 2001 M28, or

(f)

a list corresponding to any of the above lists in Scotland or Northern Ireland;

F35...

primary carer” means, in relation to an adult, the adult or organisation primarily caring for that adult;

registered patient” means —

(a)

a person who is recorded by the Local Health Board as being on the contractor’s list of patients, or

(b)

a person whom the contractor has accepted for inclusion on its list of patients, whether or not notification of that acceptance has been received by the Local Health Board and who has not been notified by the Local Health Board as having ceased to be on that list;

relevant register” means —

(a)

in relation to a nurse, the Nursing and Midwifery Register, and

(b)

in relation to a pharmacist, [F36Part 1 of the register maintained under article 19 of the Pharmacy Order 2010] or the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976 M29;

(c)

[F37in relation to a person whose name is registered in the part of the register maintained by the Health Professions Council in pursuance of Article 5 of the [F38Health and Social Work Professions Order 2001] relating to—

(i)

chiropodists and podiatrists;

(ii)

physiotherapists; or

(iii)

radiographers: diagnostic or therapeutic; that register; and

(d)

in relation to a registered optometrist, the register of optometrists maintained under section 7(a) of the Opticians Act 1989;]

repeat dispensing services” means pharmaceutical services or local pharmaceutical services which involve the provision of drugs, medicines or appliances by a chemist in accordance with a repeatable prescription;

repeatable prescribing services” means services which involve the prescribing of drugs, medicines or appliances on a repeatable prescription;

repeatable prescription” means a prescription contained in a form provided by a Local Health Board and issued by a prescriber to enable a person to obtain pharmaceutical services or local pharmaceutical services, which is in the format specified in Part 1 of Schedule 1 and which —

(a)

is generated by a computer but signed by a prescriber, and

(b)

indicates that the drugs, medicines or appliances ordered on that form may be provided more than once and specifies the number of occasions on which they may be provided;

restricted availability appliance” means an appliance which is approved for particular categories of persons or particular purposes only;

Scheduled drug” means —

(a)

a drug, medicine or other substance specified in any directions given by the Assembly under section 28U of the Act M30 as being a drug, medicine or other substance which may not be ordered for patients in the provision of medical services under the contract, or

(b)

except where the conditions in paragraph 42(2) of Schedule 6 are satisfied, a drug, medicine or other substance which is specified in any directions given by the Assembly under section 28U of the Act as being a drug, medicine or other substance which can only be ordered for specified patients and specified purposes;

section 28C provider” means a person who is providing services under a pilot scheme or in accordance with section 28C arrangements;

supplementary prescriber” means a person —

(a)

who is either engaged or employed by the contractor or is a party to the contract,

(b)

whose name is registered in —

(i)

the Nursing and Midwifery Register,

(ii)

[F39Part 1 of the register maintained under article 19 of the Pharmacy Order 2010, or]

(iii)

the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976, F40...

(iv)

[F41the part of the register maintained by the Health Professions Council in pursuance of article 5 of the [F42Health and Social Work Professions Order 2001] relating to-

(aa)

chiropodists and podiatrists;

(bb)

physiotherapists; or

(cc)

radiographers: diagnostic or therapeutic, or

(v)

the register of optometrists maintained by the General Optical Council in pursuance of section 7 of the Opticians Act 1989, and]

(c)

and against whose name is recorded in the relevant register an annotation [F43or entry] signifying that he or she is qualified to order drugs medicines and appliances as a supplementary prescriber[F44, save in the case of the Nursing and Midwifery Register, where the annotation signifies qualification as a nurse independent/supplementary prescriber];

temporary resident” means a person accepted by the contractor as a temporary resident under paragraph 16 of Schedule 6 and for whom the contractor’s responsibility has not been terminated in accordance with that paragraph;

walk-in centre” means a centre at which information and treatment for minor conditions is provided to the public under arrangements made by or on behalf of the Assembly;

working day” means any day apart from Saturday, Sunday, Christmas Day, Good Friday or a bank holiday;

“writing”, except in paragraph 102(1) of Schedule 6 and unless the context otherwise requires, includes electronic mail and “written” shall be construed accordingly.

(2) In these Regulations, the use of the term “it” in relation to the contractor shall be deemed to include a reference to a contractor that is an individual medical practitioner or two or more individuals practising in partnership and related expressions shall be construed accordingly.

[F45(3) Where the term “community practitioner nurse prescriber” appears in [F46the Human Medicines Regulations 2012] or the Nursing and Midwifery Register it is to be construed for the purposes of these Regulations as a reference to an “independent nurse prescriber”.]

Textual Amendments

Marginal Citations

M31983 c. 54; section 11(4) was amended by the National Health Service (Primary Care) Act 1997 (c. 46), section 35(4) and Schedule 2, paragraph 61(2).

M6Section 20A was inserted by section 1 of the Health (Wales) Act 2003 (c. 4).

M7Section 49S was inserted into the Act by section 27(1) of the Health and Social Care Act 2001 (c. 15) (“the 2001 Act”).

M9S.I. 1997/2817 as amended by S.I, 1998/669.

M12Section 4(2) was amended by the Health Authorities Act 1995 (c. 17) Schedule 1, paragraph 68, the Health Act 1999 (c. 8), Schedule 4, paragraph 76(a) and Schedule 5, the National Health Service Reform and Health Care Professions Act 2002 (c. 17), Schedule 1, paragraph 40, and Schedule 5, paragraph 31.

M16Local Health Boards were established under section 16BA of the Act; SI 2003/148 (W.18)

M18Section 28X was inserted into the Act by section 179(1) of the 2003 Act.

M191983 c. 54; section 2 was amended by S.I. 1996/1591 and 2002/3135.

M20Section 46 was revoked by the 2001 Act, section 67, Schedule 5, paragraphs 5 and Schedule 6, Part 1.

M21See S.I. 2001/3738, article 2(5) and (6)(b), which sets out the prescribed cases for England and S.I. 2002/1919, article 2(2) and (3)(b), which sets out the prescribed cases for Wales.

M231997 (c. 46).

M24S.I. 1997/1830 as amended by S.I 1997/2044, 1998/108, 1178 and 2081, 1999/1044 and 3463, 2000/1917, 2889 and 3231, 2001/2777, 2889 and 3942, 2002/549 and 2469 and 2003/696.

M25Section 28X was inserted into the Act by section 179(1) of the 2003 Act.

M26Section 43D was inserted into the Act by section 24 of the 2001 Act.

M271997 c. 46. Section 8ZA was inserted into that Act by section 26(2) of the 2001 Act.

M30Section 28U was inserted into the Act by section 171 of the 2003 Act. The current directions are...