Health and Social Care Bill

Health and Social Care Bill - continued	House of Commons
PART I, NATIONAL HEALTH SERVICE - continued
General and personal medical services, general dental services, general ophthalmic services and pharmaceutical services - continued

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Declaration of financial interests, gifts, etc.

25. - (1) The 1977 Act shall be amended as follows.

(2) In section 29 (arrangements and regulations for general medical services), after subsection (5) there shall be inserted-

	"(5A) Regulations may include provision as to the making of declarations about financial interests and gifts or other benefits received.
	(5B) Before making regulations by virtue of subsection (5A), the Secretary of State must consult such organisations as he thinks fit appearing to him to represent medical practitioners providing general medical services."

(3) In section 36 (regulations about general dental services), after the subsection (1A) inserted by section 23 there shall be inserted-

	"(1B) The regulations may include provision as to the making of declarations about financial interests and gifts or other benefits received.
	(1C) Before making regulations by virtue of subsection (1B), the Secretary of State must consult such organisations as he thinks fit appearing to him to represent dental practitioners and dental corporations providing general dental services."

(4) In section 39 (regulations about general ophthalmic services), after the subsection (3) inserted by section 23 there shall be inserted-

	"(4) The regulations may include provision as to the making of declarations about financial interests and gifts or other benefits received.
	(5) Before making regulations by virtue of subsection (4), the Secretary of State must consult such organisations as he thinks fit appearing to him to represent persons providing general ophthalmic services."

(5) In section 42 (regulations about pharmaceutical services)-

(a) in subsection (3), after the paragraph (k) inserted by section 23 there shall be inserted-

"(l) as to the making of declarations about financial interests and gifts or other benefits received.", and

(b) after the subsection (3B) inserted by section 45 there shall be inserted-

"(3C) Before making regulations by virtue of subsection (3)(l), the Secretary of State must consult such organisations as he thinks fit appearing to him to represent persons providing pharmaceutical services."

Supplementary lists.

26. After section 43C of the 1977 Act there shall be inserted-

"Supplementary lists.	43D. - (1) The Secretary of State may make regulations providing for the preparation and publication by each Health Authority of one or more lists of persons approved by the Health Authority for the purpose of assisting in the provision of general medical services, general dental services, general ophthalmic services and pharmaceutical services.
	(2) Such a list is referred to in this section as a "supplementary list".
	(3) The regulations may, in particular, include provision as to-
	(a) the Health Authority to which an application for inclusion in a supplementary list is to be made,
	(b) the procedure for applying for inclusion, including any information to be supplied to the Health Authority (whether by the applicant or by arrangement with him),
	(c) grounds on which the Health Authority may, or must, refuse a person's application for inclusion in a supplementary list (including his unsuitability for inclusion in such a list), or on which they may defer their decision on the application,
	(d) requirements with which a person included in a supplementary list must comply (including the declaration of financial interests and of gifts and other benefits),
	(e) grounds on which a Health Authority may, or must, suspend or remove a person from a supplementary list, the procedure for doing so, and the consequences of doing so,
	(f) payments to or in respect of persons who are suspended from a supplementary list (including provision for the amount of the payments, or the method of calculating the amount, to be determined by the Secretary of State or by another person appointed for the purpose by the Secretary of State),
	(g) the supply to the Health Authority by an applicant for inclusion in a supplementary list, or by a person included in one, of a criminal conviction certificate under section 112 of the Police Act 1997 or a criminal record certificate under section 113 of that Act,
	(h) circumstances in which a person included in a supplementary list may not withdraw from it,
	(i) criteria to be applied in making decisions under the regulations,
	(j) appeals against decisions of Health Authorities under the regulations,
	(k) the disclosure by a Health Authority, to prescribed persons or persons of prescribed descriptions, of information of a prescribed description about applicants for inclusion in a supplementary list, refusals of such applications, and suspensions and removals from that list.
	(4) Regulations made by virtue of subsection (3)(e) may (but need not) make provision corresponding to anything in sections 49F to 49K below.
	(5) If the regulations provide under subsection (3)(c) or (e) that a Health Authority may refuse a person's application for inclusion in a supplementary list, or remove a person from one, the regulations must provide for an appeal (by way of redetermination) to the FHSAA against the Health Authority's decision.
	(6) Regulations may require a person ("A") included in-
	(a) a medical list,
	(b) a list referred to in section 36(1)(a),
	(c) a list referred to in section 39(1)(a),
	(d) a list referred to in section 42(2)(a), or
	(e) a list referred to in section 43(2A),
	not to employ or engage a person ("B") to assist him in the provision of the relevant service unless B is included in a list referred to in paragraphs (a) to (e), a supplementary list, or a services list referred to in section 28DA above or section 8ZA of the National Health Service (Primary Care) Act 1997 (or, in any of those cases, such a list of a prescribed description).
	(7) If regulations do so require, they-
	(a) need not require both A and B to be included in lists prepared by the same Health Authority, but
	(b) may, in particular, require that both A and B be included in lists prepared by Health Authorities in England, or in lists prepared by Health Authorities in Wales."

Suspension and disqualification of practitioners.

27. After section 49E of the 1977 Act (which is repealed by this Act) there shall be inserted-

"Disqualification of practitioners.	49F. - (1) If it appears to a Health Authority that any of the conditions set out in subsections (2) to (4) is established in relation to a person included in any of the following prepared by them-
	(a) a medical list,
	(b) a list of medical practitioners undertaking to provide general ophthalmic services,
	(c) a list of dental practitioners and dental corporations undertaking to provide general dental services,
	(d) a list of ophthalmic opticians undertaking to provide general ophthalmic services, or
	(e) a list of persons undertaking to provide pharmaceutical services,
	(such a person being referred to in this group of sections as a "practitioner"), they may (or, in cases falling within subsection (6), must) decide to remove him from that list.
	(2) The first condition is that the continued inclusion of the person concerned in the list would be prejudicial to the efficiency of the services which those included in the list undertake to provide (and such a case is referred to in this group of sections as an "efficiency case").
	(3) The second condition is that the person concerned-
	(a) has (whether on his own or together with another) by an act or omission caused, or risked causing, detriment to any health scheme by securing or trying to secure for himself or another any financial or other benefit, and
	(b) knew that he or (as the case may be) the other was not entitled to the benefit,
	(and such a case is referred to in this group of sections as a "fraud case").
	(4) The third condition is that the person concerned is unsuitable to be included in the list (and such a case is referred to in this group of sections as an "unsuitability case").
	(5) "This group of sections" means this section and sections 49G to 49O below.
	(6) In unsuitability cases, the Health Authority must remove the practitioner from the list in prescribed circumstances.
	(7) The Health Authority must state which condition they are relying on when removing a practitioner from a list.
	(8) In subsection (3), "health scheme" means-
	(a) any of the health services under section 1(1) above or any corresponding enactment extending to Scotland or Northern Ireland, and
	(b) any prescribed scheme,
	and regulations may prescribe any scheme for the purposes of this subsection which appears to the Secretary of State to be a health or medical scheme paid for out of public funds.
	(9) Detriment to a health scheme includes detriment to any patient of, or person working in, that scheme or any person liable to pay charges for services provided under that scheme.
Contingent removal.	49G. - (1) In an efficiency case or a fraud case, the Health Authority may, instead of deciding to remove a practitioner from their list, decide to remove him contingently.
	(2) If they so decide, they must impose such conditions as they may decide on his inclusion in the list with a view to-
	(a) removing any prejudice to the efficiency of the services in question (in an efficiency case), or
	(b) preventing further acts or omissions within section 49F(3)(a) above (in a fraud case).
	(3) If the Health Authority determine that the practitioner has failed to comply with a condition, they may decide to-
	(a) vary the conditions, or impose different conditions, or
	(b) remove him from their list.
	(4) The Health Authority may decide to vary the terms of service of the person concerned for the purpose of or in connection with the imposition of any conditions by virtue of this section.
Suspension.	49H. - (1) The Health Authority may suspend a practitioner from their list-
	(a) while they decide whether or not to exercise their powers under section 49F or 49G (other than in circumstances falling within paragraph (b)), or
	(b) while they wait for a decision affecting the practitioner of a court or of the body which regulates the practitioner's profession, or one of its committees.
	(2) In a case falling within subsection (1)(a), the Health Authority must specify how long the period of suspension is to be.
	(3) In a case falling within subsection (1)(b), the Health Authority may specify that the practitioner shall remain suspended after the decision referred to there for an additional period which the Health Authority must specify.
	(4) In either case-
	(a) before that period expires they may extend, or further extend, the suspension for a further specified period, or
	(b) if that period has expired, they may impose a further suspension, for a period which they must specify.
	(5) The period of suspension (in a subsection (1)(a) case) or the additional period (in a subsection (1)(b) case), including in both cases the period of any further suspension imposed under subsection (4)(b), may not exceed six months in aggregate, except-
	(a) in prescribed circumstances, when it may not extend beyond any prescribed event (which may be the expiry of a prescribed period),
	(b) if, on the application of the Health Authority, the FHSAA orders accordingly before the expiry of the period of suspension, or
	(c) if the Health Authority have applied under paragraph (b) before the expiry of the period of suspension, but the FHSAA has not made an order by the time it expires, in which case it continues until the FHSAA has made an order.
	(6) If the FHSAA does so order, it shall specify-
	(a) the date on which the period of suspension is to end, or
	(b) an event beyond which it is not to continue.
	(7) The FHSAA may, on the application of the Health Authority, make a further order (complying with subsection (6)) at any time while the period of suspension pursuant to the earlier order is still continuing.
	(8) The Health Authority shall, or in prescribed cases may, make payments determined in accordance with regulations to any practitioner who is suspended.
	(9) The regulations may provide for the amount of the payments, or the method of calculating the amount, to be determined by the Secretary of State or by another person he appoints for the purpose.
Review of decisions.	49I. - (1) The Health Authority may, and (except in prescribed cases) if requested in writing to do so by the practitioner must, review a contingent removal or a suspension (other than a contingent removal or a suspension imposed by, or a suspension continuing pursuant to, an order of the FHSAA).
	(2) The practitioner may not request a review before the expiry of the period of three months beginning with the date of the Health Authority's decision to suspend or contingently remove him, or (as appropriate) the date of their decision on the previous review.
	(3) On such a review, the Health Authority may-
	(a) confirm the contingent removal or the suspension,
	(b) in the case of a suspension, terminate it,
	(c) in the case of a contingent removal, vary the conditions, impose different conditions, revoke the contingent removal, or remove the practitioner from the list.
Appeals.	49J. - (1) A practitioner may appeal to the FHSAA against a decision of a Health Authority mentioned in subsection (2) by giving notice in writing to the FHSAA within the period of 21 days beginning with the date on which the Health Authority gave him notice of the decision.
	(2) The Health Authority decisions in question are-
	(a) to remove the practitioner from a list (under section 49F or 49G(3)),
	(b) to remove him contingently (under section 49G),
	(c) to impose any particular condition under section 49G, or to vary any condition or to impose any different condition under that section,
	(d) to vary his terms of service (under section 49G(4)),
	(e) any decision on a review of a contingent removal under section 49I.
	(3) The appeal shall be by way of redetermination of the Health Authority's decision.
	(4) On an appeal, the FHSAA may make any decision which the Health Authority could have made.
	(5) If the FHSAA decides to remove the practitioner contingently, the Health Authority and the practitioner may each apply to the FHSAA for the conditions imposed on the practitioner to be varied, for different conditions to be imposed, or for the contingent removal to be revoked.
	(6) The Health Authority shall not remove a person from a list, or impose a contingent removal-
	(a) until the expiry of the period of 21 days referred to in subsection (1), or
	(b) if the practitioner appeals within that period, until the appeal process (including any appeal to a court from the determination of the FHSAA) is exhausted.
National disqualification.	49K. - (1) If the FHSAA removes the practitioner from a list, it may also decide to disqualify him from inclusion in-
	(a) the corresponding list of all Health Authorities,
	(b) any supplementary list of individuals of the practitioner's description (for example, "medical practitioner") prepared by any Health Authority, and
	(c) any services list of individuals of the practitioner's description prepared by any Health Authority under section 28DA above or under section 8ZA of the National Health Service (Primary Care) Act 1997,
	or any such list (or lists) of a description (or descriptions) specified by the FHSAA in its decision (such a decision being referred to in this section as a "national disqualification").
	(2) The Health Authority may apply to the FHSAA for a national disqualification to be imposed on a practitioner after they have removed him from a list of theirs.
	(3) If the FHSAA imposes a national disqualification on a practitioner-
	(a) no Health Authority may include him in a list of the kind referred to in subsection (1) prepared by them, and
	(b) if he is included in such a list, each Health Authority in whose list he is included must remove him from it.
	(4) The FHSAA may at the request of the practitioner review a national disqualification, and on a review may confirm it or revoke it.
Notification of decisions.	49L. Regulations may require a Health Authority to notify prescribed persons, or persons of prescribed descriptions, of any decision they make under this group of sections.
Withdrawal from lists.	49M. Regulations may provide for circumstances in which a practitioner-
	(a) whom a Health Authority are investigating in order to see whether there are grounds for exercising their powers under section 49F, 49G or 49H, or
	(b) who has been suspended under section 49H,
	may not withdraw from a list in which he is included.
Regulations.	49N. - (1) Any decision by a Health Authority referred to in this group of sections shall be reached in accordance with regulations made by the Secretary of State about such decisions.
	(2) The regulations shall include provision-
	(a) requiring the practitioner to be given notice of any allegation against him,
	(b) giving him the opportunity of putting his case at a hearing,
	(c) requiring him to be given notice of the Health Authority's decision and the reasons for it and of any right of appeal which he may have.
	(3) The regulations may, in particular, make provision as to criteria which the Health Authority must apply when making decisions in unsuitability cases.
Corresponding provision in Scotland and Northern Ireland.	49O. - (1) This section applies where it appears to the Secretary of State that there is provision in Scotland or Northern Ireland under which a person corresponding to a practitioner may be dealt with in any way which corresponds (whether or not exactly) with a way in which a practitioner may be dealt with under this group of sections.
	(2) A decision in Scotland or Northern Ireland to deal with such a person in such a way is referred to in this section as a "corresponding decision".
	(3) If this section applies, the Secretary of State may make regulations providing for the effect to be given in England and Wales to a corresponding decision.
	(4) That effect need not be the same as the effect of the decision in the place where it was made.
	(5) The regulations may not provide for a corresponding decision to be reviewed or revoked in England and Wales."

Personal medical services and personal dental services

PMS and PDS lists.

28. - (1) After section 28D of the 1977 Act there shall be inserted-

"Lists of persons who may perform personal medical services or personal dental services.	28DA. - (1) The Secretary of State may make regulations providing for the preparation and publication by each Health Authority of one or more lists of-
	(a) medical practitioners who may perform personal medical services in accordance with section 28C arrangements,
	(b) dental practitioners who may perform personal dental services in accordance with section 28C arrangements.
	(2) Such a list is referred to in this section as a "services list".
	(3) The regulations may, in particular, include provision as to-
	(a) the Health Authority to which an application for inclusion in a services list is to be made,
	(b) the procedure for applying for inclusion, including any information to be supplied to the Health Authority (whether by the applicant or by arrangement with him),
	(c) grounds on which the Health Authority may, or must, refuse a person's application for inclusion in a services list (including his unsuitability for inclusion in such a list), or on which they may defer their decision on the application,
	(d) requirements with which a person included in a services list must comply (including the declaration of financial interests and of gifts and other benefits),
	(e) grounds on which a Health Authority may, or must, suspend or remove a person from a services list, the procedure for doing so, and the consequences of doing so,
	(f) payments to or in respect of persons who are suspended from a services list (including provision for the amount of the payments, or the method of calculating the amount, to be determined by the Secretary of State or by another person appointed for the purpose by the Secretary of State),
	(g) the supply to the Health Authority by an applicant for inclusion in a services list, or by a person included in one, of a criminal conviction certificate under section 112 of the Police Act 1997 or a criminal record certificate under section 113 of that Act,
	(h) circumstances in which a person included in a services list may not withdraw from it,
	(i) criteria to be applied in making decisions under the regulations,
	(j) appeals against decisions of Health Authorities under the regulations,
	(k) the disclosure by a Health Authority, to prescribed persons or persons of prescribed descriptions, of information of a prescribed description about applicants for inclusion in a services list, refusals of such applications, and suspensions and removals from that list.
	(4) Regulations may provide-
	(a) that no person may perform personal medical services in accordance with section 28C arrangements unless he is included in a medical list, a supplementary list under section 43D or a services list,
	(b) that no person may perform personal dental services in accordance with section 28C arrangements unless he is included in a list referred to in section 36(1)(a), a supplementary list under section 43D or a services list.
	(5) Regulations made by virtue of subsection (3)(e) may (but need not) make provision corresponding to anything in sections 49F to 49K below.
	(6) If the regulations provide under subsection (3)(c) or (e) that a Health Authority may refuse a person's application for inclusion in a services list, or remove a person from one, the regulations must provide for an appeal (by way of redetermination) to the FHSAA against the Health Authority's decision.".

(2) After section 8 of the National Health Service (Primary Care) Act 1997 there shall be inserted-

	"Services Lists
Lists of persons who may perform personal medical services or personal dental services.	8ZA. - (1) The Secretary of State may make regulations providing for the preparation and publication by each Health Authority of one or more lists of-
	(a) medical practitioners who may perform personal medical services in connection with the provision of such services under a pilot scheme,
	(b) dental practitioners who may perform personal dental services in connection with the provision of such services under a pilot scheme.
	(2) Such a list is referred to in this section as a "services list".
	(3) The regulations may, in particular, include provision as to-
	(a) the Health Authority to which an application for inclusion in a services list is to be made,
	(b) the procedure for applying for inclusion, including any information to be supplied to the Health Authority (whether by the applicant or by arrangement with him),
	(c) grounds on which the Health Authority may, or must, refuse a person's application for inclusion in a services list (including his unsuitability for inclusion in such a list), or on which they may defer their decision on the application,
	(d) requirements with which a person included in a services list must comply (including the declaration of financial interests and of gifts and other benefits),
	(e) grounds on which a Health Authority may, or must, suspend or remove a person from a services list, the procedure for doing so, and the consequences of doing so,
	(f) payments to or in respect of persons who are suspended from a services list (including provision for the amount of the payments, or the method of calculating the amount, to be determined by the Secretary of State or by another person appointed for the purpose by the Secretary of State),
	(g) the supply to the Health Authority by an applicant for inclusion in a services list, or by a person included in one, of a criminal conviction certificate under section 112 of the Police Act 1997 or a criminal record certificate under section 113 of that Act,
	(h) circumstances in which a person included in a services list may not withdraw from it,
	(i) criteria to be applied in making decisions under the regulations,
	(j) appeals against decisions of Health Authorities under the regulations,
	(k) the disclosure by a Health Authority, to prescribed persons or persons of prescribed descriptions, of information of a prescribed description about applicants for inclusion in a services list, refusals of such applications, and suspensions and removals from that list.
	(4) Regulations may provide-
	(a) that no person may perform personal medical services unless he is included in a medical list, a supplementary list under section 43D of the 1977 Act or a services list,
	(b) that no person may perform personal dental services unless he is included in a list referred to in section 36(1)(a) of the 1977 Act, a supplementary list under section 43D of that Act or a services list.
	(5) Regulations made by virtue of subsection (3)(e) may (but need not) make provision corresponding to anything in sections 49F to 49K of the 1977 Act.
	(6) If the regulations provide under subsection (3)(c) or (e) that a Health Authority may refuse a person's application for inclusion in a services list, or remove a person from one, the regulations must provide for an appeal (by way of redetermination) to the Family Health Services Appeal Authority against the Health Authority's decision.".

(3) In section 40(3) of the National Health Service (Primary Care) Act 1997 (interpretation) after "sections 28C" there shall be inserted ", 28DA".

The Family Health Services Appeal Authority

The Family Health Services Appeal Authority.

29. - (1) After section 49O of the 1977 Act (which is inserted by section 27 of this Act) there shall be inserted-

	"The Family Health Services Appeal Authority
The Family Health Services Appeal Authority.	49P. - (1) There shall be a body to be known as the Family Health Services Appeal Authority ("FHSAA").
	(2) The FHSAA shall be constituted in accordance with Schedule 9A to this Act, which also makes other provision in relation to the FHSAA.
	(3) The FHSAA shall have such functions as are conferred on it by this Act or by any other enactment.
	(4) The Secretary of State may direct the FHSAA to exercise any of his functions relating to the determination of appeals to him which are specified in the directions; and, if he does so, he may also give it directions about its exercise of those functions.
	(5) Directions under subsection (4) shall be given by regulations or by an instrument in writing."

(2) In section 128(1) of the 1977 Act (interpretation), in the appropriate place there shall be inserted-

""FHSAA" means the Family Health Services Appeal Authority;".

(3) Before Schedule 10 to the 1977 Act there shall be inserted-

	"SCHEDULE 9A
	THE FAMILY HEALTH SERVICES APPEAL AUTHORITY
	Constitution
	1. The Family Health Services Appeal Authority ("FHSAA") shall consist of-
	(a) a President appointed by the Lord Chancellor; and
	(b) a number of other members appointed by the Lord Chancellor.
	2. The number of the other members shall be determined by the Lord Chancellor with the consent of the Secretary of State.
	3. A person appointed as the President shall have a 10 year general qualification (within the meaning of section 71 of the Courts and Legal Services Act 1990).
	4. The person appointed as the President-
	(a) may not continue to hold office after he reaches the age of 70; and
	(b) may be removed from office by the Lord Chancellor on grounds of incapacity or misbehaviour.
	5. The other members must include at least one-
	(a) medical practitioner providing general medical services;
	(b) medical practitioner providing general ophthalmic services;
	(c) dental practitioner providing general dental services;
	(d) ophthalmic optician providing general ophthalmic services; and
	(e) registered pharmacist providing pharmaceutical services,
	and must also include a number of lay persons who do not fall within paragraphs (a) to (e) and who possess such qualifications and experience as the Lord Chancellor considers appropriate.
	6. The Secretary of State may pay the President and other members such remuneration and such allowances as he thinks fit.
	Procedure
	7. The procedure of the FHSAA shall be as it determines, subject to the following.
	8. The FHSAA shall secure that-
	(a) each party to proceedings before the FHSAA is given the opportunity of putting his case at a hearing,
	(b) each such party is entitled to be legally represented at such a hearing,
	(c) each such party is given notice of the FHSAA's decision and the reasons for it."

(4) In the National Health Service (Primary Care) Act 1997-

(a) in section 22 (supplementary regulations about personal medical or dental services), in the section 28E to be inserted into the 1977 Act, in subsection (7)(e), for "Tribunal constituted under section 46" there shall be substituted "Family Health Services Appeal Authority constituted under section 49P"; and

(b) in Schedule 1 (preferential treatment on transferring to medical lists), in paragraph 9(a), for "Tribunal constituted under section 46" there shall be substituted "Family Health Services Appeal Authority constituted under section 49P".

Prepared 9 February 2001