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General medical services contracts |
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84 | General medical services contracts: introductory |
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(1) | A Primary Care Trust may enter into a contract under which primary medical |
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services are provided in accordance with the following provisions of this Part. |
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(2) | A contract under this section is called in this Act a “general medical services |
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(3) | A general medical services contract may make such provision as may be |
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agreed between the Primary Care Trust and the contractor or contractors in |
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(a) | the services to be provided under the contract, |
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(b) | remuneration under the contract, and |
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(4) | The services to be provided under a general medical services contract may |
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(a) | services which are not primary medical services, |
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(b) | services to be provided outside the area of the Primary Care Trust. |
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(5) | In this Part, “contractor”, in relation to a general medical services contract, |
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means any person entering into the contract with the Primary Care Trust. |
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85 | Requirement to provide certain primary medical services |
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(1) | A general medical services contract must require the contractor or contractors |
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to provide, for his or their patients, primary medical services of such |
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descriptions as may be prescribed. |
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(2) | Regulations under subsection (1) may in particular describe services by |
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reference to the manner or circumstances in which they are provided. |
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86 | Persons eligible to enter into GMS contracts |
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(1) | A Primary Care Trust may, subject to such conditions as may be prescribed, |
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enter into a general medical services contract with— |
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(a) | a medical practitioner, |
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(b) | two or more individuals practising in partnership where the conditions |
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in subsection (2) are satisfied, or |
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(c) | a company limited by shares where the conditions in subsection (3) are |
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(2) | The conditions referred to in subsection (1)(b) are that— |
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(a) | at least one partner is a medical practitioner, and |
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(b) | any partner who is not a medical practitioner is either— |
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(ii) | a section 92 employee, section 107 employee, section 50 |
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employee, section 64 employee, section 17C employee or Article |
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(iii) | a health care professional who is engaged in the provision of |
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services under this Act or the National Health Service (Wales) |
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|
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(iv) | an individual falling within section 93(1)(d). |
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(3) | The conditions referred to in subsection (1)(c) are that— |
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(a) | at least one share in the company is legally and beneficially owned by |
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a medical practitioner, and |
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(b) | any share which is not so owned is legally and beneficially owned by a |
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person referred to in subsection (2)(b). |
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(4) | Regulations may make provision as to the effect, in relation to a general |
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medical services contract entered into by individuals practising in partnership, |
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of a change in the membership of the partnership. |
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“health care professional”, “NHS employee”, “section 92 employee”, |
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“section 107 employee”, “section 50 employee”, “section 64 employee”, |
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“section 17C employee” and “Article 15B employee” have the meaning |
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87 | GMS contracts: payments |
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(1) | The Secretary of State may give directions as to payments to be made under |
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general medical services contracts. |
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(2) | A general medical services contract must require payments to be made under |
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the contract in accordance with directions under this section. |
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(3) | Directions under subsection (1) may in particular— |
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(a) | provide for payments to be made by reference to compliance with |
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standards or the achievement of levels of performance, |
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(b) | provide for payments to be made by reference to— |
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(i) | any scheme or scale specified in the direction, or |
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(ii) | a determination made by any person in accordance with factors |
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specified in the direction, |
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(c) | provide for the making of payments in respect of individual |
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(d) | provide that the whole or any part of a payment is subject to conditions |
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(and may provide that payments are payable by a Primary Care Trust |
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only if it is satisfied as to certain conditions), |
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(e) | make provision having effect from a date before the date of the |
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direction, provided that, having regard to the direction as a whole, the |
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provision is not detrimental to the persons to whose remuneration it |
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(4) | Before giving a direction under subsection (1), the Secretary of State— |
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(a) | must consult any body appearing to him to be representative of persons |
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to whose remuneration the direction would relate, and |
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(b) | may consult such other persons as he considers appropriate. |
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(5) | “Payments” includes fees, allowances, reimbursements, loans and repayments. |
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88 | GMS contracts: prescription of drugs, etc |
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(1) | A general medical services contract must contain provision requiring the |
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contractor or contractors to comply with any directions given by the Secretary |
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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 |
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medical services under the contract. |
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(2) | A direction under this section must, subject to subsection (3), be given by |
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(3) | A direction under this section may be given by an instrument in writing where |
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it gives effect to a request made in writing to the Secretary of State by a person |
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who is a holder of a Community marketing authorization or United Kingdom |
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marketing authorisation in respect of the drug, medicine or other substance to |
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which the request relates. |
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(4) | “Community marketing authorization” and “United Kingdom marketing |
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authorisation” have the meaning given by regulation 1 of the Medicines for |
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Human Use (Marketing Authorisations Etc.) Regulations 1994 (S.I. 1994/ |
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89 | GMS contracts: other required terms |
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(1) | A general medical services contract must contain such provision as may be |
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prescribed (in addition to the provision required by the preceding provisions |
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(2) | Regulations under subsection (1) may in particular make provision as to— |
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(a) | the manner in which, and standards to which, services must be |
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(b) | the persons who perform services, |
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(c) | the persons to whom services will be provided, |
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(d) | the variation of contract terms (other than terms required by or under |
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(e) | rights of entry and inspection (including inspection of clinical records |
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(f) | the circumstances in which, and the manner in which, the contract may |
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(h) | the adjudication of disputes. |
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(3) | Regulations making provision under subsection (2)(c) may make provision as |
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to the circumstances in which a contractor or contractors— |
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(a) | must or may accept a person as a patient to whom services are provided |
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(b) | may decline to accept a person as such a patient, or |
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(c) | may terminate his or their responsibility for a patient. |
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(4) | Regulations under subsection (2)(d) may— |
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(a) | make provision as to the circumstances in which a Primary Care Trust |
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may impose a variation of contract terms, |
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(b) | make provision as to the suspension or termination of any duty under |
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the contract to provide services of a prescribed description. |
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(5) | Regulations making provision of the kind described in subsection (4)(b) may |
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prescribe services by reference to the manner or circumstances in which they |
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|
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(6) | Regulations under subsection (1) must make provision as to the right of |
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patients to choose the persons from whom they receive services. |
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90 | GMS contracts: disputes and enforcement |
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(1) | Regulations may make provision for the resolution of disputes as to the terms |
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of a proposed general medical services contract. |
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(2) | Regulations under subsection (1) may make provision— |
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(a) | for the referral of the terms of the proposed contract to the Secretary of |
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(b) | for the Secretary of State, or a person appointed by him, to determine |
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the terms on which the contract may be entered into. |
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(3) | Regulations may make provision for a person or persons entering into a |
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general medical services contract to be regarded as a health service body for |
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any purposes of section 9, in circumstances where he or they so elect. |
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(4) | Regulations under subsection (3) may include provision as to the application |
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of section 9 in cases where— |
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(a) | persons practising in partnership elect to become a health service body, |
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(b) | there is a change in the membership of the partnership. |
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(a) | by virtue of regulations under subsection (3), section 9(11) applies in |
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relation to a general medical services contract, and |
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(b) | a direction as to payments is made under that subsection in relation to |
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| the direction is enforceable in a county court (if the court so orders) as if it were |
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a judgment or order of that court. |
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Performance of primary medical services |
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91 | Persons performing primary medical services |
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(1) | Regulations may provide that a health care professional of a prescribed |
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description may not perform any primary medical service for which a Primary |
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Care Trust is responsible unless he is included in a list maintained under the |
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regulations by a Primary Care Trust. |
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(2) | For the purposes of this section— |
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(a) | “health care professional” means a person who is a member of a |
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profession regulated by a body mentioned in section 25(3) of the |
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National Health Service Reform and Health Care Professions Act 2002 |
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(b) | a Primary Care Trust is responsible for a medical service if it provides |
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the service, or secures its provision, by or under any enactment. |
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(3) | Regulations under this section may make provision in relation to lists under |
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this section and in particular as to— |
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(a) | the preparation, maintenance and publication of a list, |
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(b) | eligibility for inclusion in a list, |
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|
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|
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(c) | applications for inclusion (including provision as to the Primary |
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Care Trust to which an application must be made, and for the |
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procedure for applications and the documents to be supplied on |
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(d) | the grounds on which an application for inclusion may or must be |
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(e) | requirements with which a person included in a list must comply |
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(including the declaration of financial interests and gifts and other |
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(f) | suspension or removal from a list (including provision for the |
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grounds for, and consequences of, suspension or removal), |
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(g) | circumstances in which a person included in a list may not withdraw |
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(h) | payments to be made in respect of a person suspended from a list |
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(including provision for the amount of the payment, or the method of |
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calculating the payment, to be determined by the Secretary of State or a |
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person appointed by him), |
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(i) | the criteria to be applied in making decisions under the regulations, |
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(j) | appeals against decisions made by a Primary Care Trust under the |
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(k) | disclosure of information about applicants for inclusion, grants or |
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refusals of applications or suspensions or removals, |
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| and may make any provision corresponding to anything in sections 151 to 159. |
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(4) | Regulations under this section may, in particular, also provide for— |
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(a) | a person’s inclusion in a list to be subject to conditions determined by |
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(b) | a Primary Care Trust to vary the conditions or impose different ones, |
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(c) | the consequences of failing to comply with a condition (including |
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(d) | the review by a Primary Care Trust of decisions made by it by virtue of |
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(5) | The imposition of such conditions must be with a view to— |
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(a) | preventing any prejudice to the efficiency of the services to which a list |
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(6) | Regulations making provision as to the matters referred to in subsection (3)(k) |
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may in particular authorise the disclosure of information— |
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(a) | by a Primary Care Trust to the Secretary of State, and |
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(b) | by the Secretary of State to a Primary Care Trust. |
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Other arrangements for the provision of primary medical services |
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92 | Arrangements by Strategic Health Authorities for the provision of primary |
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(1) | A Strategic Health Authority may make one or more agreements with respect |
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to its area under which primary medical services are provided (otherwise than |
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by the Strategic Health Authority). |
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(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 |
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medical services with arrangements for the provision of primary dental |
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(4) | An agreement may not combine arrangements for the provision of primary |
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medical services with arrangements for the provision of local pharmaceutical |
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(5) | But an agreement may include arrangements for the provision of services |
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which are not primary medical services but which may be provided under this |
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Act, other than under Chapter 1 or 2 of Part 7 (pharmaceutical services and |
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local pharmaceutical services under pilot schemes). |
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(6) | This Act has effect, in relation to primary medical services provided under an |
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agreement, as if those services were provided as a result of the delegation by |
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the Secretary of State of his functions (by directions given under section 7). |
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(7) | Regulations may provide— |
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(a) | for functions which are exercisable by a Strategic Health Authority in |
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relation to an agreement to be exercisable on behalf of the Strategic |
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Health Authority by a Health Board, and |
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(b) | for functions which are exercisable by a Health Board in relation to |
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an agreement made under section 17C of the National Health Service |
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(Scotland) Act 1978 (c. 29) to be exercisable on behalf of the Board by a |
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Strategic Health Authority. |
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(8) | In this Act, arrangements for the provision of services made under this section |
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are called “section 92 arrangements”. |
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93 | Persons with whom agreements may be made under section 92 |
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(1) | A Strategic Health Authority may make an agreement under section 92 only |
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with one or more of the following— |
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(a) | an NHS trust or an NHS foundation trust, |
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(b) | a medical practitioner who meets the prescribed conditions, |
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(c) | a health care professional who meets the prescribed conditions, |
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(d) | an individual who is providing services— |
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(i) | under a general medical services contract or a general dental |
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services contract or a Welsh general medical services contract or |
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a Welsh general dental services contract, |
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(ii) | in accordance with section 92 arrangements, section 107 |
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arrangements, section 50 arrangements, section 64 |
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arrangements, section 17C arrangements or Article 15B |
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(iii) | under section 17J or 25 of the 1978 Act or Article 57 or 61 of the |
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Health and Personal Social Services (Northern Ireland) Order |
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1972 (S.I. 1972/1265 (N.I.14)), |
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| or has so provided them within such period as may be prescribed, |
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(e) | an NHS employee, a section 92 employee, a section 107 employee, a |
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section 50 employee, a section 64 employee, a section 17C employee or |
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(g) | a Primary Care Trust or Local Health Board. |
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|
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|
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(2) | The power under subsection (1) to make an agreement with a person falling |
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within paragraph (d) or (e) of that subsection is subject to such conditions as |
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“the 1978 Act” means the National Health Service (Scotland) Act 1978 |
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“Article 15B arrangements” means arrangements for the provision of |
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services made under Article 15B of the Health and Personal Social |
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Services (Northern Ireland) Order 1972 (S.I. 1972/1265 (N.I.14)), |
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“Article 15B employee” means an individual who, in connection with the |
| 10 |
provision of services in accordance with Article 15B arrangements, is |
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employed by a person providing or performing those services, |
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“health care professional” means a person who is a member of a |
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profession regulated by a body mentioned (at the time the agreement |
| |
in question is made) in section 25(3) of the National Health Service |
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Reform and Health Care Professions Act 2002 (c. 17), |
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“NHS employee” means an individual who, in connection with the |
| |
provision of services in the health service, the Scottish health service or |
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the Northern Ireland health service, is employed by— |
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(a) | an NHS trust, an NHS foundation trust or (in Northern Ireland) |
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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 |
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(d) | an individual who is providing services as specified in |
| |
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“the Northern Ireland health service” means the health service within the |
| |
meaning of the Health and Personal Social Services (Northern Ireland) |
| 30 |
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“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) |
| |
| |
“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, |
| |
|
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|