National Health Service Bill [HL]

House of Commons

Session 2005 - 06
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National Health Service Bill [HL]

National Health Service Bill [HL]
Part 4 — Medical services
43

General medical services contracts
84
General medical services contracts: introductory
(1)
A Primary Care Trust may enter into a contract under which primary medical
services are provided in accordance with the following provisions of this Part.
(2)
A contract under this section is called in this Act a “general medical services
5
contract”.
(3)
A general medical services contract may make such provision as may be
agreed between the Primary Care Trust and the contractor or contractors in
relation to—
(a)
the services to be provided under the contract,
10
(b)
remuneration under the contract, and
(c)
any other matters.
(4)
The services to be provided under a general medical services contract may
include—
(a)
services which are not primary medical services,
15
(b)
services to be provided outside the area of the Primary Care Trust.
(5)
In this Part, “contractor”, in relation to a general medical services contract,
means any person entering into the contract with the Primary Care Trust.
85
Requirement to provide certain primary medical services
(1)
A general medical services contract must require the contractor or contractors
20
to provide, for his or their patients, primary medical services of such
descriptions as may be prescribed.
(2)
Regulations under subsection (1) may in particular describe services by
reference to the manner or circumstances in which they are provided.
86
Persons eligible to enter into GMS contracts
25
(1)
A Primary Care Trust may, subject to such conditions as may be prescribed,
enter into a general medical services contract with—
(a)
a medical practitioner,
(b)
two or more individuals practising in partnership where the conditions
in subsection (2) are satisfied, or
30
(c)
a company limited by shares where the conditions in subsection (3) are
satisfied.
(2)
The conditions referred to in subsection (1)(b) are that—
(a)
at least one partner is a medical practitioner, and
(b)
any partner who is not a medical practitioner is either—
35
(i)
an NHS employee,
(ii)
a section 92 employee, section 107 employee, section 50
employee, section 64 employee, section 17C employee or Article
15B employee,
(iii)
a health care professional who is engaged in the provision of
40
services under this Act or the National Health Service (Wales)
Act 2006 (c. 00), or

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Part 4 — Medical services
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(iv)
an individual falling within section 93(1)(d).
(3)
The conditions referred to in subsection (1)(c) are that—
(a)
at least one share in the company is legally and beneficially owned by
a medical practitioner, and
(b)
any share which is not so owned is legally and beneficially owned by a
5
person referred to in subsection (2)(b).
(4)
Regulations may make provision as to the effect, in relation to a general
medical services contract entered into by individuals practising in partnership,
of a change in the membership of the partnership.
(5)
In this section—
10
“health care professional”, “NHS employee”, “section 92 employee”,
“section 107 employee”, “section 50 employee”, “section 64 employee”,
“section 17C employee” and “Article 15B employee” have the meaning
given by section 93.
87
GMS contracts: payments
15
(1)
The Secretary of State may give directions as to payments to be made under
general medical services contracts.
(2)
A general medical services contract must require payments to be made under
the contract in accordance with directions under this section.
(3)
Directions under subsection (1) may in particular—
20
(a)
provide for payments to be made by reference to compliance with
standards or the achievement of levels of performance,
(b)
provide for payments to be made by reference to—
(i)
any scheme or scale specified in the direction, or
(ii)
a determination made by any person in accordance with factors
25
specified in the direction,
(c)
provide for the making of payments in respect of individual
practitioners,
(d)
provide that the whole or any part of a payment is subject to conditions
(and may provide that payments are payable by a Primary Care Trust
30
only if it is satisfied as to certain conditions),
(e)
make provision having effect from a date before the date of the
direction, provided that, having regard to the direction as a whole, the
provision is not detrimental to the persons to whose remuneration it
relates.
35
(4)
Before giving a direction under subsection (1), the Secretary of State—
(a)
must consult any body appearing to him to be representative of persons
to whose remuneration the direction would relate, and
(b)
may consult such other persons as he considers appropriate.
(5)
“Payments” includes fees, allowances, reimbursements, loans and repayments.
40
88
GMS contracts: prescription of drugs, etc
(1)
A general medical services contract must contain provision requiring the
contractor or contractors to comply with any directions given by the Secretary
of State for the purposes of this section as to the drugs, medicines or other

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substances which may or may not be ordered for patients in the provision of
medical services under the contract.
(2)
A direction under this section must, subject to subsection (3), be given by
regulations.
(3)
A direction under this section may be given by an instrument in writing where
5
it gives effect to a request made in writing to the Secretary of State by a person
who is a holder of a Community marketing authorization or United Kingdom
marketing authorisation in respect of the drug, medicine or other substance to
which the request relates.
(4)
“Community marketing authorization” and “United Kingdom marketing
10
authorisation” have the meaning given by regulation 1 of the Medicines for
Human Use (Marketing Authorisations Etc.) Regulations 1994 (S.I. 1994/
3144).
89
GMS contracts: other required terms
(1)
A general medical services contract must contain such provision as may be
15
prescribed (in addition to the provision required by the preceding provisions
of this Part).
(2)
Regulations under subsection (1) may in particular make provision as to—
(a)
the manner in which, and standards to which, services must be
provided,
20
(b)
the persons who perform services,
(c)
the persons to whom services will be provided,
(d)
the variation of contract terms (other than terms required by or under
this Part),
(e)
rights of entry and inspection (including inspection of clinical records
25
and other documents),
(f)
the circumstances in which, and the manner in which, the contract may
be terminated,
(g)
enforcement,
(h)
the adjudication of disputes.
30
(3)
Regulations making provision under subsection (2)(c) may make provision as
to the circumstances in which a contractor or contractors—
(a)
must or may accept a person as a patient to whom services are provided
under the contract,
(b)
may decline to accept a person as such a patient, or
35
(c)
may terminate his or their responsibility for a patient.
(4)
Regulations under subsection (2)(d) may—
(a)
make provision as to the circumstances in which a Primary Care Trust
may impose a variation of contract terms,
(b)
make provision as to the suspension or termination of any duty under
40
the contract to provide services of a prescribed description.
(5)
Regulations making provision of the kind described in subsection (4)(b) may
prescribe services by reference to the manner or circumstances in which they
are provided.

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(6)
Regulations under subsection (1) must make provision as to the right of
patients to choose the persons from whom they receive services.
90
GMS contracts: disputes and enforcement
(1)
Regulations may make provision for the resolution of disputes as to the terms
of a proposed general medical services contract.
5
(2)
Regulations under subsection (1) may make provision—
(a)
for the referral of the terms of the proposed contract to the 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.
10
(3)
Regulations may make provision for a person or persons entering into a
general medical services contract to be regarded as a health service body for
any purposes of section 9, in circumstances where he or they so elect.
(4)
Regulations under subsection (3) may include provision as to the application
of section 9 in cases where—
15
(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—
(a)
by virtue of regulations under subsection (3), section 9(11) applies in
20
relation to a general medical services contract, and
(b)
a direction as to payments is made under that subsection in relation to
the contract,

the direction is enforceable in a county court (if the court so orders) as if it were
a judgment or order of that court.
25
Performance of primary medical services
91
Persons performing primary medical services
(1)
Regulations may provide that a health care professional of a prescribed
description may not perform any primary medical service for which a Primary
Care Trust is responsible unless he is included in a list maintained under the
30
regulations by a Primary Care Trust.
(2)
For the purposes of this section—
(a)
“health care professional” means a person who is a member of a
profession regulated by a body mentioned in section 25(3) of the
National Health Service Reform and Health Care Professions Act 2002
35
(c. 17),
(b)
a Primary Care Trust is responsible for a medical service if it provides
the service, or secures its provision, by or under any enactment.
(3)
Regulations under this section may make provision in relation to lists under
this section and in particular as to—
40
(a)
the preparation, maintenance and publication of a list,
(b)
eligibility for inclusion in a list,

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(c)
applications for inclusion (including provision as to the Primary
Care Trust to which an application must be made, and for the
procedure for applications and the documents to be supplied on
application),
(d)
the grounds on which an application for inclusion may or must be
5
granted or refused,
(e)
requirements with which a person included in a list must comply
(including the declaration of financial interests and gifts and other
benefits),
(f)
suspension or removal from a list (including provision for the
10
grounds for, and consequences of, suspension or removal),
(g)
circumstances in which a person included in a list may not withdraw
from it,
(h)
payments to be made in respect of a person suspended from a list
(including provision for the amount of the payment, or the method of
15
calculating the payment, to be determined by the Secretary of State or a
person appointed by him),
(i)
the criteria to be applied in making decisions under the regulations,
(j)
appeals against decisions made by a Primary Care Trust under the
regulations, and
20
(k)
disclosure of information about applicants for inclusion, grants or
refusals of applications or suspensions or removals,

and may make any provision corresponding to anything in sections 151 to 159.
(4)
Regulations under this section may, in particular, also provide for—
(a)
a person’s inclusion in a list to be subject to conditions determined by
25
a Primary Care Trust,
(b)
a Primary Care Trust to vary the conditions or impose different ones,
(c)
the consequences of failing to comply with a condition (including
removal from a list),
(d)
the review by a Primary Care Trust of decisions made by it by virtue of
30
the regulations.
(5)
The imposition of such conditions must be with a view to—
(a)
preventing any prejudice to the efficiency of the services to which a list
relates, or
(b)
preventing fraud.
35
(6)
Regulations making provision as to the matters referred to in subsection (3)(k)
may in particular authorise the disclosure of information—
(a)
by a Primary Care Trust to the Secretary of State, and
(b)
by the Secretary of State to a Primary Care Trust.
Other arrangements for the provision of primary medical services
40
92
Arrangements by Strategic Health Authorities for the provision of primary
medical services
(1)
A Strategic Health Authority may make one or more agreements with respect
to its area under which primary medical services are provided (otherwise than
by the Strategic Health Authority).
45
(2)
An agreement must be in accordance with regulations under section 94.

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(3)
An agreement may not combine arrangements for the provision of primary
medical services with arrangements for the provision of primary dental
services.
(4)
An agreement may not combine arrangements for the provision of primary
medical services with arrangements for the provision of local pharmaceutical
5
services.
(5)
But an agreement may include arrangements for the provision of services
which are not primary medical services but which may be provided under this
Act, other than under Chapter 1 or 2 of Part 7 (pharmaceutical services and
local pharmaceutical services under pilot schemes).
10
(6)
This Act has effect, in relation to primary medical services provided under an
agreement, as if those services were provided as a result of the delegation by
the Secretary of State of his functions (by directions given under section 7).
(7)
Regulations may provide—
(a)
for functions which are exercisable by a Strategic Health Authority in
15
relation to an agreement to be exercisable on behalf of the Strategic
Health Authority by a Health Board, and
(b)
for functions which are exercisable by a Health Board in relation to
an agreement made under section 17C of the National Health Service
(Scotland) Act 1978 (c. 29) to be exercisable on behalf of the Board by a
20
Strategic Health Authority.
(8)
In this Act, arrangements for the provision of services made under this section
are called “section 92 arrangements”.
93
Persons with whom agreements may be made under section 92
(1)
A Strategic Health Authority may make an agreement under section 92 only
25
with one or more of the following—
(a)
an NHS trust or an NHS foundation trust,
(b)
a medical practitioner who meets the prescribed conditions,
(c)
a health care professional who meets the prescribed conditions,
(d)
an individual who is providing services—
30
(i)
under a general medical services contract or a general dental
services contract or a Welsh general medical services contract or
a Welsh general dental services contract,
(ii)
in accordance with section 92 arrangements, section 107
arrangements, section 50 arrangements, section 64
35
arrangements, section 17C arrangements or Article 15B
arrangements, or
(iii)
under section 17J or 25 of the 1978 Act or Article 57 or 61 of the
Health and Personal Social Services (Northern Ireland) Order
1972 (S.I. 1972/1265 (N.I.14)),
40

or has so provided them within such period as may be prescribed,
(e)
an NHS employee, a section 92 employee, a section 107 employee, a
section 50 employee, a section 64 employee, a section 17C employee or
an Article 15B employee,
(f)
a qualifying body,
45
(g)
a Primary Care Trust or Local Health Board.

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(2)
The power under subsection (1) to make an agreement with a person falling
within paragraph (d) or (e) of that subsection is subject to such conditions as
may be prescribed.
(3)
In this section—
“the 1978 Act” means the National Health Service (Scotland) Act 1978
5
(c. 29),
“Article 15B arrangements” means arrangements for the provision of
services made under Article 15B of the Health and Personal Social
Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I.14)),
“Article 15B employee” means an individual who, in connection with the
10
provision of services in accordance with Article 15B arrangements, is
employed by a person providing or performing those services,
“health care professional” means a person who is a member of a
profession regulated by a body mentioned (at the time the agreement
in question is made) in section 25(3) of the National Health Service
15
Reform and Health Care Professions Act 2002 (c. 17),
“NHS employee” means an individual who, in connection with the
provision of services in the health service, the Scottish health service or
the Northern Ireland health service, is employed by—
(a)
an NHS trust, an NHS foundation trust or (in Northern Ireland)
20
a Health and Social Services Trust,
(b)
a Primary Care Trust or Local Health Board,
(c)
a person who is providing services under a general medical
services contract or a general dental services contract or a Welsh
general medical services contract or a Welsh general dental
25
services contract,
(d)
an individual who is providing services as specified in
subsection (1)(d)(iii),
“the Northern Ireland health service” means the health service within the
meaning of the Health and Personal Social Services (Northern Ireland)
30
Order 1972,
“qualifying body” means a company which is limited by shares all of
which are legally and beneficially owned by persons falling within
paragraph (a), (b), (c), (d), (e) or (g) of subsection (1),
“the Scottish health service” means the health service within the meaning
35
of the National Health Service (Scotland) Act 1978,
“section 17C arrangements” means arrangements for the provision of
services made under section 17C of the 1978 Act,
“section 17C employee” means an individual who, in connection with the
provision of services in accordance with section 17C arrangements, is
40
employed by a person providing or performing those services,
“section 50 arrangements” means arrangements for the provision of
services made under section 50 of the National Health Service (Wales)
Act 2006 (c. 00),
“section 64 arrangements” means arrangements for the provision of
45
services made under section 64 of that Act,
“section 107 employee” means an individual who, in connection with the
provision of services in accordance with section 107 arrangements, is
employed by a person providing or performing those services,