Health Bill

House of Commons

Session 2005 - 06
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Health Bill

Health Bill
Part 4 — The National Health Service
Chapter 2 — Ophthalmic services
33

28WF
  GOS contracts: disputes and enforcement
(1)
Regulations may make provision for the resolution of disputes as to the
terms of a proposed general ophthalmic services contract.
(2)
Regulations under subsection (1) may make provision—
(a)
for the referral of the terms of the proposed contract to the
5
Secretary of State; and
(b)
for the Secretary of State, or a person appointed by him, to
determine the terms on which the contract may be entered into.
(3)
Regulations may make provision for a person or persons entering into
a general ophthalmic services contract to be regarded, in circumstances
10
where he or they so elect, as a health service body for the purposes of
section 4 of the National Health Service and Community Care Act 1990,
but only so far as concerns the general ophthalmic services contract
(and not for any other purpose).
(4)
Regulations under subsection (3) may include provision as to the
15
application of section 4 of that Act in cases where—
(a)
persons practising in partnership elect to become a health
service body; and
(b)
there is a change in the membership of the partnership.
(5)
Where—
20
(a)
by virtue of regulations under subsection (3), subsection (7) of
section 4 of that Act applies in relation to a general ophthalmic
services contract, and
(b)
a direction as to payments is made under that provision in
relation to the contract,
25

the direction is to be enforceable in a county court (if the court so
orders) as if it were a judgment or order of that court.”
36
Persons performing primary ophthalmic services
(1)
Section 28X of the 1977 Act (persons performing primary medical and dental
services) is amended as follows.
30
(2)
After subsection (2) insert—
“(2A)
Regulations may provide that a health care professional of a prescribed
description may not perform any primary ophthalmic service for which
a Primary Care Trust is responsible unless he is included in a list
maintained under the regulations by a Primary Care Trust.”
35
(3)
In subsection (3)(b), for “medical or dental” substitute “medical, dental or
ophthalmic”.
(4)
After subsection (6) insert—
“(6A)
Regulations under this section may, in particular, also prescribe the
qualifications and experience which a medical practitioner who applies
40
for inclusion in a list mentioned in subsection (2A) must have, and
may—
(a)
provide for the practitioner to show to the satisfaction of a
committee recognised by the Secretary of State for the purpose
that he possesses such qualifications and experience;
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Health Bill
Part 4 — The National Health Service
Chapter 2 — Ophthalmic services
34

(b)
confer on a person who is dissatisfied with the determination of
such a committee a right of appeal to a committee appointed by
the Secretary of State; and
(c)
provide for anything which appears to the Secretary of State to
be appropriate in connection with that right of appeal.”
5
(5)
In the heading, for “medical and dental” substitute “medical, dental and
ophthalmic”.
37
Assistance and support
(1)
Section 28Y of the 1977 Act (assistance and support for providers of primary
medical and dental services) is amended as follows.
10
(2)
For paragraph (a) of subsection (1) substitute—
“(a)
any person providing, or proposing to provide, primary
medical services under a general medical services contract,
primary dental services under a general dental services
contract, or primary ophthalmic services under a general
15
ophthalmic services contract;”.
(3)
In paragraph (b) of subsection (1), for “such services” substitute “primary
medical or dental services”.
38
Local Optical Committees
After section 45B of the 1977 Act insert—
20
“45C
Local Optical Committees: England
(1)
A Primary Care Trust may recognise a committee formed for its area,
or for its area and that of one or more other Primary Care Trusts, which
it is satisfied is representative of—
(a)
the persons to whom subsection (2) applies; and
25
(b)
the persons to whom subsection (3) applies.
(2)
This subsection applies to every person who, under a general
ophthalmic services contract entered into by him, is providing primary
ophthalmic services in the area for which the committee is formed.
(3)
This subsection applies to every optometrist not falling within
30
subsection (2)—
(a)
who is performing primary ophthalmic services in the area for
which the committee is formed, whether under section
16CD(4)(a) above, or under a general ophthalmic services
contract, and
35
(b)
who has notified the Primary Care Trust that he wishes to be
represented by the committee (and has not notified it that he
wishes to cease to be so represented).
(4)
A committee recognised under this section shall be called the Local
Optical Committee for the area for which it is formed.
40
(5)
Any such committee may delegate any of its functions, with or without
restrictions or conditions, to sub-committees composed of members of
that committee.

Health Bill
Part 4 — The National Health Service
Chapter 2 — Ophthalmic services
35

(6)
Any such committee may co-opt persons not falling within subsection
(2) or (3) on such terms as it thinks fit.
(7)
Regulations may require a Primary Care Trust, in the exercise of its
functions relating to primary ophthalmic services, to consult any
committee recognised by it under this section on such occasions and to
5
such extent as may be prescribed.
(8)
A committee recognised under this section shall have such other
functions as may be prescribed.
(9)
A committee recognised under this section shall in respect of each year
determine—
10
(a)
the amount of its administrative expenses for that year
attributable to persons of whom it is representative under
subsection (1)(a); and
(b)
the amount of its administrative expenses for that year
attributable to persons of whom it is representative under
15
subsection (1)(b).
(10)
A Primary Care Trust may—
(a)
on the request of a committee recognised by it, allot to that
committee such sums as it may determine for defraying the
expenses referred to in subsection (9)(a), together with a
20
reasonable proportion of the committee’s administrative
expenses attributable to any co-opted members; and
(b)
deduct the amount of such sums from the remuneration of
persons of whom it is representative under subsection (1)(a)
under the general ophthalmic services contracts entered into by
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them with the Trust.
(11)
A committee recognised under this section shall apportion the amount
determined by it under subsection (9)(b), together with the remainder
of the committee’s administrative expenses attributable to any co-
opted members, among the persons of whom it is representative under
30
subsection (1)(b); and each such person shall pay in accordance with
the committee’s directions the amount so apportioned to him.
(12)
References in this section to the administrative expenses of a committee
include the travelling and subsistence allowances payable to its
members.”
35
39
Payments in respect of optical appliances
(1)
Schedule 12 to the 1977 Act (which makes provision about charges and
payments) is amended as follows.
(2)
In paragraph 2A(1)—
(a)
for paragraph (b) substitute—
40
“(b)
for a person whose resources fall to be treated under
the regulations as being less than or equal to his
requirements;
(ba)
for any person falling within section 16CD(2)(d)
above; or”,
45
(b)
after “paragraph (a), (b)” insert “, (ba)”.

Health Bill
Part 4 — The National Health Service
Chapter 2 — Ophthalmic services
36

(3)
After paragraph 2A insert—
“2B   (1)
Regulations under paragraph 2A above providing for payments for
meeting or contributing towards the cost incurred for the supply of
optical appliances or their replacement or repair may also provide as
follows, but in relation to England only.
5
      (2)
They may make provision for such payments not to be made to any
person falling within a prescribed description.
      (3)
They may make provision for the Secretary of State to give notice as
mentioned in sub-paragraph (4) to a person to whom such payments
have been made (whether by the Secretary of State or by an authority
10
established under this Act).
      (4)
Such a notice is notice that no further such payments in respect of the
supply, replacement or repair of optical appliances at a particular
location or in a particular area, in either case specified in the notice,
will be made to him after a date specified in the notice.
15
      (5)
If such a notice is given, no further payments as mentioned in sub-
paragraph (4) are to be made to him after the date specified in the
notice, unless the notice is cancelled by the Secretary of State.
      (6)
The regulations may make provision conferring on the Secretary of
State the right, if he has given a notice by virtue of sub-paragraph (3),
20
to apply to the FHSAA for a stop order.
      (7)
A stop order is an order that no further such payments are to be
made (whether by the Secretary of State or by any authority
established under this Act) to the person in question in respect of the
supply, replacement or repair of optical appliances, wherever the
25
supply, replacement or repair occurred.
      (8)
If the regulations make the provision mentioned in sub-paragraph
(3), they must also make provision conferring prescribed rights of
appeal to the FHSAA upon the person to whom the notice was
given.”
30
40
General ophthalmic services: transitional
(1)
The Secretary of State shall in regulations make transitional provision in
respect of persons who, immediately before the coming into force of section 35,
are providing services in England under section 38 of the 1977 Act (general
ophthalmic services).
35
(2)
Regulations under this section may provide that, in such circumstances as the
regulations may specify, a Primary Care Trust must, if any such person so
wishes, enter into a general ophthalmic services contract with him; and the
regulations may make provision as to the terms of any such contract.
(3)
Regulations under this section may provide that, in such circumstances as the
40
regulations may specify, a Primary Care Trust must, if any such person so
wishes, enter into a contract with him, containing such terms as the regulations
may specify, for the provision of ophthalmic services.
(4)
Regulations under this section may make provision for the resolution of
disputes in relation to any contract entered into, or proposed to be entered into,
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Health Bill
Part 4 — The National Health Service
Chapter 3 — Protection of NHS from fraud and other unlawful activities
37

under subsection (2) or (3), including provision for the determination of
disputes by the Secretary of State or a person appointed by him.
(5)
Regulations under this section may make provision in respect of a period
beginning before the coming into force of the provision (or of section 35), but
such provision must not as a whole be detrimental to the remuneration of the
5
persons to whom it relates.
(6)
In this section, “general ophthalmic services contract” means a contract under
section 28WA of the 1977 Act (as inserted by section 35(1)).
Chapter 3
Protection of NHS from fraud and other unlawful activities
10
Preliminary
41
Compulsory disclosure of documents for purposes of counter fraud or
security management functions
(1)
This Chapter confers power to require the production of documents in
connection with the exercise of—
15
(a)
the appropriate national authority’s counter fraud functions in relation
to the health service in England or (as the case may be) Wales, or
(b)
the Secretary of State’s security management functions in relation to the
health service in England.
(2)
The appropriate national authority’s “counter fraud functions” in relation to
20
the health service in England or Wales means that authority’s power (by virtue
of section 2(b) of the 1977 Act) to take action for the purpose of preventing,
detecting or investigating fraud, corruption or other unlawful activities carried
out against or otherwise affecting—
(a)
the health service in England or (as the case may be) Wales, or
25
(b)
that authority in relation to the authority’s responsibilities for the
health service in England or (as the case may be) Wales.
(3)
The Secretary of State’s “security management functions” in relation to the
health service in England means the Secretary of State’s power (by virtue of
section 2(b) of the 1977 Act) to take action for the purpose of protecting and
30
improving the security of—
(a)
persons employed by the Secretary of State or an NHS body in the
provision of services for the purposes of the health service in England
(“English NHS services”);
(b)
health service providers and persons employed by them so far as they
35
or (as the case may be) persons so employed are engaged in any activity
directly related to the provision of English NHS services;
(c)
NHS contractors and persons employed by them so far as they or (as
the case may be) persons so employed are engaged in any activity
directly related to the provision of English NHS services;
40
(d)
persons not within paragraphs (a) to (c) who work in any capacity on
premises used by the Secretary of State, an NHS body, a health service
provider, or an NHS contractor, in connection with the provision of
English NHS services;
(e)
persons on such premises—
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Health Bill
Part 4 — The National Health Service
Chapter 3 — Protection of NHS from fraud and other unlawful activities
38

(i)
who are there for the purpose of receiving, or are receiving or
have received, treatment or other services as patients, or
(ii)
who are accompanying persons within sub-paragraph (i);
(f)
property and information used or held by the Secretary of State, an
NHS body, a health service provider, or an NHS contractor, in
5
connection with the provision of English NHS services.
(4)
In this Chapter—
(a)
the appropriate national authority’s counter fraud functions in relation
to the health service in England or (as the case may be) Wales, and
(b)
the Secretary of State’s security management functions in relation to the
10
health service in England,

are collectively referred to as functions to which this Chapter applies.
(5)
In this section “investigating” means investigating in relation to civil or
criminal proceedings.
42
Meaning of “NHS body” etc.
15
(1)
This section applies for the purposes of this Chapter.
(2)
Subject to subsection (3), an “NHS body” means—
(a)
a Strategic Health Authority,
(b)
a Local Health Board,
(c)
a Special Health Authority,
20
(d)
a Primary Care Trust,
(e)
an NHS trust, or
(f)
an NHS foundation trust.
(3)
In section 41(3), and in section 43(1) so far as having effect in relation to the
Secretary of State’s security management functions referred to in section 41(3),
25
an “NHS body” means—
(a)
a Strategic Health Authority,
(b)
a Special Health Authority so far as performing functions in respect of
England,
(c)
a Primary Care Trust,
30
(d)
an NHS trust all or most of whose hospitals, establishments and
facilities are situated in England, or
(e)
an NHS foundation trust.
(4)
A “health service provider” means any person (other than a body within
subsection (2)) providing primary medical services, primary dental services,
35
primary or general ophthalmic services, or pharmaceutical services.
(5)
An “NHS contractor” means any person (other than a body or person within
subsection (2) or (4)) providing services of any description under arrangements
made with an NHS body.
(6)
A “statutory health body” means any body (other than a body within
40
subsection (2), (4) or (5)) established by or under an enactment and—
(a)
providing services in connection with the provision of, or
(b)
exercising functions in relation to,

the health service in either England or Wales or both.

Health Bill
Part 4 — The National Health Service
Chapter 3 — Protection of NHS from fraud and other unlawful activities
39

(7)
The appropriate national authority may by order—
(a)
make such amendments of any of subsections (2) to (6) as the authority
considers appropriate;
(b)
make such consequential amendments of this Chapter as the authority
considers appropriate.
5
Disclosure notices
43
Notice requiring production of documents
(1)
This section applies if it appears to the appropriate national authority that
there are reasonable grounds for suspecting—
(a)
that any documents containing information relevant to the exercise of
10
any of the authority’s functions to which this Chapter applies are in the
possession or under the control of any NHS body, statutory health
body, health service provider or NHS contractor (“the relevant
organisation”), and
(b)
that a person within subsection (3) is accountable for the documents.
15
(2)
The appropriate national authority may serve on that person a notice requiring
him to produce the documents to an authorised officer.
(3)
The persons within this subsection are—
(a)
any member, officer or director of the relevant organisation;
(b)
any other person who takes part in the management of the affairs of
20
that organisation;
(c)
any person employed by that organisation; and
(d)
(in the case of a health service provider or NHS contractor who is an
individual) that individual.
(4)
A notice under this section must specify or describe the documents to which it
25
relates.
(5)
Subject to subsections (6) and (7), the notice may require those documents to be
produced—
(a)
at or by such time as is specified in the notice, or at once, and
(b)
at such place, and in such manner, as is so specified.
30
(6)
When specifying a time at or by which the documents are to be produced, the
notice must not require them to be produced otherwise than at a reasonable
hour.
(7)
If the notice requires documents to be produced at once, it may only be served
at a reasonable hour.
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(8)
An authorised officer may, by agreement with the person served with a notice
within subsection (6) or (7), vary the notice so as to extend the time for
compliance with it.
(9)
Any notice under this section, and any variation of such a notice under
subsection (8), must be in writing.
40
(10)
For the purposes of this section an individual is “accountable” for any
documents if he has either day-to-day, or an overall, responsibility for the
custody or control of the documents.