National Health Service (Wales) Bill [HL]

House of Commons

Session 2005 - 06
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Other Bills before Parliament

National Health Service (Wales) Bill [HL]

National Health Service (Wales) Bill [HL]
Part 3 — Local authorities and the NHS
22

38
Supply of goods and services by the Welsh Ministers
(1)
The Welsh Ministers may supply to—
(a)
local authorities, and
(b)
such public bodies or classes of public bodies as the Welsh Ministers
may determine,
5

any goods or materials of a kind used in the health service.
(2)
In subsection (1) “public bodies” includes public bodies in Northern Ireland.
(3)
The Welsh Ministers may make available to persons falling within subsection
(1)—
(a)
any facilities provided by them or by a Primary Care Trust for any
10
service under this Act, and
(b)
the services of persons employed by the Welsh Ministers or by a Local
Health Board, a Primary Care Trust or a Special Health Authority.
(4)
The Welsh Ministers may carry out maintenance work (including minor
renewals, minor improvements and minor extensions) in connection with any
15
land or building for the maintenance of which a local authority is responsible.
(5)
The Welsh Ministers may supply or make available to persons—
(a)
providing general ophthalmic services or pharmaceutical services,
(b)
providing services under a general medical services contract or a
general dental services contract, or
20
(c)
providing services in accordance with section 50 arrangements or
section 64 arrangements,

such goods, materials or other facilities as may be prescribed.
(6)
The Welsh Ministers must make available to local authorities—
(a)
any services (other than the services of any person) or other facilities
25
provided under this Act,
(b)
the services provided as part of the health service by any person
employed by the Welsh Ministers, a Primary Care Trust, a Special
Health Authority or a Local Health Board, and
(c)
the services of any medical practitioner, dental practitioner or nurse
30
employed by the Welsh Ministers, a Primary Care Trust, a Special
Health Authority or a Local Health Board otherwise than to provide
services which are part of the health service,

so far as is reasonably necessary and practicable to enable local authorities to
discharge their functions relating to social services, education and public
35
health.
(7)
The Welsh Ministers may arrange to make available to local authorities the
services of persons—
(a)
providing general ophthalmic services or pharmaceutical services,
(b)
performing services under a general medical services contract or a
40
general dental services contract,
(c)
providing services in accordance with section 50 arrangements or
section 64 arrangements,
(d)
providing Local Health Boards, Primary Care Trusts or Special Health
Authorities with services of a kind provided as part of the health
45
service,

National Health Service (Wales) Bill [HL]
Part 3 — Local authorities and the NHS
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so far as is reasonably necessary and practicable to enable local authorities to
discharge their functions relating to social services, education and public
health.
39
Conditions of supply under section 38
(1)
The Welsh Ministers must, before they make available the services of any
5
officer under subsection (3)(b) of section 38, or subsection (6)(b) or (c) of that
section—
(a)
consult the officer or a body recognised by the Welsh Ministers as
representing the officer, or
(b)
satisfy themselves that the body who employs the officer has consulted
10
the officer about the matter.
(2)
The Welsh Ministers may disregard the provisions of subsection (1) in a case
where they—
(a)
consider it necessary to make the services of an officer available for the
purpose of dealing temporarily with an emergency, and
15
(b)
have previously consulted a body such as is mentioned in subsection
(1)(b) about making services available in an emergency.
(3)
The Welsh Ministers may, for the purposes of subsection (3)(b) of section 38, or
subsection (6)(b) or (c) of that section, give such directions to Primary Care
Trusts, Special Health Authorities and Local Health Boards to make the
20
services of their officers available as the Welsh Ministers consider appropriate.
(4)
Powers under this section and section 38 may be exercised on such terms as
may be agreed, including terms as to the making of payments to the Welsh
Ministers.
(5)
The Welsh Ministers may make such charges in respect of services or facilities
25
provided under section 38(6) as may be agreed between the Welsh Ministers
and the local authority or, in default of agreement, as may be determined by
arbitration.
(6)
Any power to supply goods or materials under section 38 includes—
(a)
a power to purchase and store them, and
30
(b)
a power to arrange with third parties for the supply of goods or
materials by those third parties.
40
Health and well-being strategies in Wales
(1)
Each local authority in Wales, and each Local Health Board any part of whose
area lies within the area of the local authority, must jointly formulate and
35
implement a strategy for the health and well-being of members of the public in
the local authority’s area (a “health and well-being strategy”).
(2)
The local authority and the Local Health Board (or Boards) responsible for a
health and well-being strategy are referred to in this section as the “responsible
bodies”.
40
(3)
The responsible bodies must have regard to their strategy in the exercise of
their functions.
(4)
Each strategy must be formulated in relation to a period of time specified in
regulations.

National Health Service (Wales) Bill [HL]
Part 4 — Medical services
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(5)
The Welsh Ministers may by regulations make further provision about health
and well-being strategies.
(6)
The regulations may, in particular, make provision as to—
(a)
the imposition of a duty on the responsible bodies to co-operate in
formulating their strategy with prescribed persons or descriptions of
5
person (including, for example, NHS trusts, Community Health
Councils, voluntary bodies, and local businesses),
(b)
steps which the responsible bodies must take before formulating the
strategy,
(c)
matters which the strategy must address,
10
(d)
publication of the strategy,
(e)
monitoring and review by the responsible bodies of the strategy and
its implementation,
(f)
the production of information and reports by the responsible bodies
in relation to the strategy,
15
(g)
the avoidance of duplication in the preparation of health and well-
being strategies and other prescribed strategies or plans provided for
under any other enactment.
(7)
The Welsh Ministers may—
(a)
give directions to local authorities in Wales, Local Health Boards and
20
NHS trusts in connection with health and well-being strategies,
(b)
issue guidance to responsible bodies in connection with them.
(8)
The power to give directions under subsection (7)(a) does not affect any other
power to give directions.
(9)
In this section—
25
“local authority” means a county council or county borough council,
“NHS trust” means an NHS trust all or most of whose hospitals,
establishments and facilities are situated in Wales.
Part 4
Medical services
30
Duty of Local Health Boards in relation to primary medical services
41
Primary medical services
(1)
Each Local Health Board must, to the extent that it considers necessary to meet
all reasonable requirements, exercise its powers so as to provide primary
medical services within its area, or secure their provision within its area.
35
(2)
A Local Health Board may (in addition to any other power conferred on it)—
(a)
provide primary medical services itself (whether within or outside its
area),
(b)
make such arrangements for their provision (whether within or outside
its area) as it considers appropriate, and may in particular make
40
contractual arrangements with any person.

National Health Service (Wales) Bill [HL]
Part 4 — Medical services
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(3)
Each Local Health Board must publish information about such matters as may
be prescribed in relation to the primary medical services provided under this
Act.
(4)
Each Local Health Board must co-operate with each other Local Health Board
and each Primary Care Trust in the discharge of their respective functions
5
relating to the provision of primary medical services under this Act and the
National Health Service Act 2006 (c. 00).
(5)
Regulations may provide that services of a prescribed description must, or
must not, be regarded as primary medical services for the purposes of this Act.
(6)
Regulations under this section may in particular describe services by reference
10
to the manner or circumstances in which they are provided.
General medical services contracts
42
General medical services contracts: introductory
(1)
A Local Health Board may enter into a contract under which primary medical
services are provided in accordance with the following provisions of this Part.
15
(2)
A contract under this section is called in this Act a “general medical services
contract”.
(3)
A general medical services contract may make such provision as may be
agreed between the Local Health Board and the contractor or contractors in
relation to—
20
(a)
the services to be provided under the contract,
(b)
remuneration under the contract, and
(c)
any other matters.
(4)
The services to be provided under a general medical services contract may
include—
25
(a)
services which are not primary medical services,
(b)
services to be provided outside the area of the Local Health Board.
(5)
In this Part, “contractor”, in relation to a general medical services contract,
means any person entering into the contract with the Local Health Board.
43
Requirement to provide certain primary medical services
30
(1)
A general medical services contract must require the contractor or contractors
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.
35
44
Persons eligible to enter into GMS contracts
(1)
A Local Health Board 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
40
in subsection (2) are satisfied, or

National Health Service (Wales) Bill [HL]
Part 4 — Medical services
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(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—
5
(i)
an NHS employee,
(ii)
a section 50 employee, section 64 employee, section 92
employee, section 107 employee, section 17C employee or
Article 15B employee,
(iii)
a health care professional who is engaged in the provision of
10
services under this Act or the National Health Service Act 2006
(c. 00),or
(iv)
an individual falling within section 51(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
15
a medical practitioner, and
(b)
any share which is not so owned is legally and beneficially owned by a
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,
20
of a change in the membership of the partnership.
(5)
In this section—
“health care professional”, “NHS employee”, “section 50 employee”,
“section 64 employee”, “section 92 employee”, “section 107 employee”,
“section 17C employee” and “Article 15B employee” have the meaning
25
given by section 51.
45
GMS contracts: payments
(1)
The Welsh Ministers 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
30
the contract in accordance with directions under this section.
(3)
Directions under subsection (1) may in particular—
(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—
35
(i)
any scheme or scale specified in the direction, or
(ii)
a determination made by any person in accordance with factors
specified in the direction,
(c)
provide for the making of payments in respect of individual
practitioners,
40
(d)
provide that the whole or any part of a payment is subject to conditions
(and may provide that payments are payable by a Local Health Board
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
45

National Health Service (Wales) Bill [HL]
Part 4 — Medical services
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provision is not detrimental to the persons to whose remuneration it
relates.
(4)
Before giving a direction under subsection (1), the Welsh Ministers—
(a)
must consult any body appearing to them to be representative of
persons to whose remuneration the direction would relate, and
5
(b)
may consult such other persons as they consider appropriate.
(5)
“Payments” includes fees, allowances, reimbursements, loans and repayments.
46
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 Welsh
10
Ministers for the purposes of this section as to the drugs, medicines or other
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.
15
(3)
A direction under this section may be given by an instrument in writing where
it gives effect to a request made in writing to the Welsh Ministers 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.
20
(4)
“Community marketing authorization” and “United Kingdom marketing
authorisation” have the meaning given by regulation 1 of the Medicines for
Human Use (Marketing Authorisations Etc.) Regulations 1994 (S.I. 1994/
3144).
47
GMS contracts: other required terms
25
(1)
A general medical services contract must contain such provision as may be
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
30
provided,
(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),
35
(e)
rights of entry and inspection (including inspection of clinical records
and other documents),
(f)
the circumstances in which, and the manner in which, the contract may
be terminated,
(g)
enforcement,
40
(h)
the adjudication of disputes.
(3)
Regulations making provision under subsection (2)(c) may make provision as
to the circumstances in which a contractor or contractors—

National Health Service (Wales) Bill [HL]
Part 4 — Medical services
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(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
(c)
may terminate his or their responsibility for a patient.
(4)
Regulations under subsection (2)(d) may—
5
(a)
make provision as to the circumstances in which a Local Health Board
may impose a variation of contract terms,
(b)
make provision as to the suspension or termination of any duty under
the contract to provide services of a prescribed description.
(5)
Regulations making provision of the kind described in subsection (4)(b) may
10
prescribe services by reference to the manner or circumstances in which they
are provided.
(6)
Regulations under subsection (1) must make provision as to the right of
patients to choose the persons from whom they receive services.
48
GMS contracts: disputes and enforcement
15
(1)
Regulations may make provision for the resolution of disputes as to the terms
of a proposed general medical services contract.
(2)
Regulations under subsection (1) may make provision—
(a)
for the referral of the terms of the proposed contract to the Welsh
Ministers, and
20
(b)
for the Welsh Ministers, or a person appointed by them, 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 medical services contract to be regarded as a health service body for
any purposes of section 7, in circumstances where he or they so elect.
25
(4)
Regulations under subsection (3) may include provision as to the application
of section 7 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.
30
(5)
Where—
(a)
by virtue of regulations under subsection (3), section 7(11) applies in
relation to a general medical services contract, and
(b)
a direction as to payments is made under that subsection in relation to
the contract,
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the direction is enforceable in a county court (if the court so orders) as if it were
a judgment or order of that court.
Performance of primary medical services
49
Persons performing primary medical services
(1)
Regulations may provide that a health care professional of a prescribed
40
description may not perform any primary medical service for which a Local
Health Board is responsible unless he is included in a list maintained under the
regulations by a Local Health Board.