[F1[F2Part IU.K. Pilot Schemes for Primary Care

Preparation and making of pilot schemesE+W+S

1 Pilot schemes.E+W+S

(1)In this Act “pilot scheme” means one or more agreements made by an authority with respect to their area and in accordance with this Part under which—

(a)personal medical services are provided (otherwise than by the authority); [F3or]

(b)personal dental services are provided (otherwise than by the authority).

(2)A pilot scheme may not combine arrangements for the provision of [F4personal medical services with arrangements for the provision of personal dental services [F5, and may not combine arrangements for the provision of personal medical services or] personal dental services with arrangements for the provision of local pharmaceutical services under LPS schemes (within the meaning of paragraph 1(3) of Schedule 8A to the National Health Service Act 1997 or under pilot schemes made under section 28 of the Health and Social Care Act 2001].

(3)A pilot scheme may include arrangements for the provision of services—

(a)which are not [F6personal medical services or] personal dental services; but

(b)which [F7(not being primary medical services) ] may be provided under Part I of the M1National Health Service Act 1977 or (as the case may be) Part I or III of the M2National Health Service (Scotland) Act 1978.

(4)In this Act “piloted services” means services provided in accordance with a pilot scheme (including any services to which the scheme applies by virtue of subsection (3)).

(5)Except to such extent as may be prescribed—

(a)[F8a patient for whom personal medical services are provided under a pilot scheme is not to count as a person for whom arrangements must be made by the authority concerned under section 29 of the 1977 Act or section 19 of the 1978 Act;]

(b)a patient for whom personal dental services are provided under a pilot scheme is not to count as a person for whom arrangements must be made by the authority concerned under section 35 of the 1977 Act or section 25 of the 1978 Act.

(6)Regulations may provide—

(a)for functions which are exercisable by a [F9Strategic Health Authority or a]Health Authority in relation to a pilot scheme to be exercisable on behalf of the Authority by a Health Board; and

(b)for functions which are exercisable by a [F9Strategic Health Authority or a]Health Board in relation to a pilot scheme to be exercisable on behalf of the Board by a Health Authority.

(7)The functions of an NHS trust [F10and a Primary Care Trust] include power to provide piloted services, and to do so as a member of a qualifying body (within the meaning of section 2 or 3).

(8)For the purposes of this Part—

• “authority” means—

[F11(a)in relation to England, a Strategic Health Authority;

(aa)in relation to Wales, a Health Authority; and]

(b)in relation to Scotland, a Health Board;

• [F12“personal medical services” means medical services of a kind that may be provided by a general medical practitioner in accordance with arrangements made under Part II of the 1977 Act or (as the case may be) Part II of the 1978 Act; and]

• [F12“personal dental services” means dental services of a kind that may be provided by a general dental practitioner [F13(or, in England and Wales, a dental corporation)]in accordance with arrangements made under Part II of the 1977 Act or (as the case may be) Part II of the 1978 Act.]

2 Provision of personal medical services under a pilot scheme.E+W+S

(1)This section applies to any pilot scheme under which personal medical services are provided.

(2)[F14An agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may be made by an authority only with one or more of the following—

(a)an NHS trust;

(b)a suitably experienced medical practitioner;

(c)an NHS employee or a pilot scheme employee;

(d)a qualifying body;

(e)an individual who is providing personal medical services under that or another pilot scheme.

F15[(f)a Primary Care Trust]]

(3)In this section—

• “NHS employee” means an individual who, in connection with the provision of services in the health service, is employed by—

  (a)

  an NHS trust;

  (b)

  a medical practitioner whose name is included in a medical list; or

  (c)

  a medical practitioner who is providing personal medical services in accordance with a pilot scheme;

• “pilot scheme employee” means an individual who, in connection with the provision of personal medical services in accordance with a pilot scheme, is employed by an individual providing those services;

• “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) [F16(e) or (f)] of subsection (2).

(4)For the purposes of this section, a medical practitioner is suitably experienced if he is suitably experienced for the purposes of section 11 of this Act, section 31 of the 1977 Act or section 21 of the 1978 Act.

(5)In this Part, “medical list” means—

(a)in relation to England and Wales, a list prepared in accordance with regulations made under section 29(2)(a) of the 1977 Act;

(b)in relation to Scotland, a list prepared in accordance with regulations made under section 19(2)(a) of the 1978 Act.

3 Provision of personal dental services under a pilot scheme.E+W+S

(1)This section applies to any pilot scheme under which personal dental services are provided.

(2)An agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may be made by an authority only with one or more of the following—

(a)an NHS trust;

(b)a dental practitioner whose name is included in a dental list;

(c)an NHS employee or a pilot scheme employee;

(d)a qualifying body;

(e)an individual who is providing personal dental services under that or another pilot scheme.

F17[(f)a Primary Care Trust]

(3)In this section—

• “dental list” means—

  (a)

  in relation to England and Wales, a list prepared in accordance with regulations made under section 36(1)(a) of the 1977 Act;

  (b)

  in relation to Scotland, a list prepared in accordance with regulations made under section 25(2)(a) of the 1978 Act;

• “NHS employee” means an individual who, in connection with the provision of services in the health service, is employed by—

  (a)

  an NHS trust;

  (b)

  a dental practitioner whose name is included in a dental list; or

  (c)

  a dental practitioner who is providing personal dental services in accordance with a pilot scheme;

• “pilot scheme employee” means an individual who, in connection with the provision of personal dental services in accordance with a pilot scheme, is employed by an individual providing those services;

• “qualifying body” means—

  (a)

  a body corporate which, in accordance with the provisions of Part IV of the M3Dentists Act 1984, is entitled to carry on the business of dentistry; or

  (b)

  a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (c) [F18(e) or (f)] of subsection (2).

4 Proposals for pilot schemes.E+W+S

(1)Before any pilot scheme may be made, the authority concerned must prepare proposals for the scheme and submit them to the Secretary of State.

(2)An authority must prepare and submit such proposals if they are asked to do so by a person—

(a)who wishes to provide piloted services, and

(b)with whom an agreement which constitutes, or is part of, a pilot scheme may be made;

but otherwise they may not do so.

(3)A request to an authority under subsection (2) must—

(a)be made in writing; and

(b)comply with such requirements (if any) as may be prescribed.

(4)In preparing proposals for a pilot scheme, an authority must comply with any directions given to them by the Secretary of State as to the matters to be dealt with, and information to be included, in the proposals.

(5)Before submitting proposals for a pilot scheme, an authority must (in addition to complying with any requirements about consultation imposed by or under any other enactment) comply with any directions given to them by the Secretary of State about the extent to which, and manner in which, they are to consult on the proposals.

(6)The Secretary of State may give directions as to—

(a)the matters to which an authority must have regard in making any recommendation to the Secretary of State when submitting proposals for a pilot scheme; and

(b)the form in which any such recommendation is to be made.

5 Approval of pilot schemes.E+W+S

(1)If proposals for a pilot scheme are submitted to the Secretary of State under section 4, he must—

(a)approve them as submitted;

(b)make such modifications as he considers appropriate and approve them as modified; or

(c)reject them.

(2)The Secretary of State may not approve proposals for a pilot scheme unless he is satisfied that they include satisfactory provision for any participant other than the authority to withdraw from the scheme if he wishes to do so.

(3)Subsection (4) applies if—

(a)the Secretary of State intends to approve proposals for a pilot scheme; and

(b)it appears to him that the effect of implementing the proposals would be to increase or reduce the number of general practitioners in the area of the authority concerned.

(4)[F19The Secretary of State must have regard to the effect that the proposals, as he intends to approve them, are likely to have on—

(a)the distribution of general practitioners in England, in the case of proposals submitted by an authority in England;

(b)the distribution of general practitioners in Scotland, in the case of proposals submitted by an authority in Scotland;

(c)the distribution of general practitioners in Wales, in the case of proposals submitted by an authority in Wales.]

[F20(5)[F21In carrying out his functions under subsection (4) in relation to the distribution of general practitioners in Scotland, the Secretary of State must consult the Scottish Medical Practices Committee.]]

(6)The Secretary of State must notify the authority concerned, in writing, of any decision made under this section.

(7)[F22In this section “general practitioner” means any medical practitioner who is providing general medical services or performing personal medical services.]

6 Making of pilot schemes.E+W+S

(1)If the Secretary of State approves proposals for a pilot scheme and notifies the authority concerned in accordance with section 5, the authority must implement the proposals in accordance with directions given by the Secretary of State.

(2)A proposed participant in a pilot scheme (other than the authority concerned) may withdraw at any time before the proposals relating to him are implemented.

(3)A pilot scheme, as implemented, may differ from the proposals for the scheme approved by the Secretary of State only if the Secretary of State agrees to the variation or—

(a)directions given by the Secretary of State (either under subsection (1) or generally) authorise variations that satisfy specified requirements; and

(b)the variation satisfies those requirements.

(4)As soon as is reasonably practicable after implementing proposals for a pilot scheme, the authority concerned must (in accordance with any directions given to them by the Secretary of State) publish details of the scheme.

Reviews of pilot schemesE+W+S

7 Reviews of pilot schemes.E+W+S

(1)At least one review of the operation of each pilot scheme must be conducted by the Secretary of State.

(2)Each pilot scheme must be reviewed under this section before the end of the period of three years beginning with the date on which piloted services are first performed under the scheme.

(3)When conducting a review of a pilot scheme, the Secretary of State must give—

(a)the authority concerned, and

(b)any person providing services under the scheme,

an opportunity to comment on any matter relevant to the review.

(4)Otherwise, the procedure on any review is to be determined by the Secretary of State.

Variation and termination of pilot schemesE+W+S

8 Variation and termination of pilot schemes.E+W+S

(1)The Secretary of State may by directions require a pilot scheme to be varied by the authority concerned in accordance with the directions.

(2)Directions under subsection (1) may be given—

(a)in response to a request made by the authority or by any other participant in the scheme; or

(b)on the Secretary of State’s own initiative.

(3)The Secretary of State may give directions authorising authorities to vary pilot schemes (otherwise than in response to directions given under subsection (1)) in such circumstances, and subject to such conditions, as may be specified in the directions.

(4)If the Secretary of State is satisfied that a pilot scheme is (for any reason) unsatisfactory, he may give directions to the authority concerned requiring them to bring the scheme to an end in accordance with the terms of the directions.

[F23Services Lists]E+W+S

[8ZAF24 Lists of persons who may perform personal medical services or personal dental servicesE+W+S

(1)The Secretary of State may make regulations providing for the preparation and publication [F25by each Primary Care Trust and]]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 [F26Primary Care Trust or]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 [F26Primary Care Trust or]Health Authority (whether by the applicant or by arrangement with him),

(c)grounds on which the [F26Primary Care Trust or]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 [F26Primary Care Trust or]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 [F26Primary Care Trust or]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 (c. 50), a criminal record certificate under section 113 of that Act or an enhanced criminal record certificate under section 115 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 [F27Primary Care Trusts and]Health Authorities under the regulations,

(k)the disclosure by a [F26Primary Care Trust or]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)The regulations may, in particular, also provide for—

(a)a person’s inclusion in a services list to be subject to conditions determined by the [F28Primary Care Trust or]Health Authority,

(b)the [F28Primary Care Trust or]Health Authority to vary the conditions or impose different ones,

(c)the consequences of failing to comply with a condition (including removal from the list), and

(d)the review by the [F28Primary Care Trust or]Health Authority of their decisions made by virtue of regulations under this subsection.

(5)The imposition of such conditions must be with a view to—

(a)preventing any prejudice to the efficiency of the services to which the services list relates; or

(b)preventing any acts or omissions of the type described in section 49F(3)(a) of the 1977 Act.

(6)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.

(7)Regulations made by virtue of subsection (3)(e) may (but need not) make provision corresponding to anything in sections 49F to 49N of the 1977 Act.

(8)If the regulations provide under subsection (3)(e) or (4) that a [F29Primary Care Trust or]Health Authority may suspend or remove a person from a services list, they must include provision—

(a)requiring him to be given notice of any allegation against him;

(b)giving him the opportunity of putting his case at a hearing before the [F29Primary Care Trust or]Health Authority make any decision as to his suspension or removal; and

(c)requiring him to be given notice of the [F30decision of the Primary Care Trust or of the Health Authority] and the reasons for it and of any right of appeal under subsection (9) or (10).

(9)If the regulations provide under subsection (3)(c) or (e) that a [F31Primary Care Trust or]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 (“FHSAA”) against the [F32decision of the Primary Care Trust or of the Health Authority].

(10)If the regulations make provision under subsection (4), they must provide for an appeal (by way of redetermination) by the person in question to the FHSAA against the [F33decision of the Primary Care Trust or of the Health Authority]—

(a)to impose conditions, or any particular condition,

(b)to vary a condition,

(c)to remove him from the services list for breach of condition,

(d)on any review of an earlier such decision of theirs.

[8AF34Delegation of Health Authority functions relating to pilot schemes.E+W+S

[F35(1)A Strategic Health Authority may not, under section 17A of the 1977 Act, direct a Primary Care Trust to exercise any functions of the Strategic Health Authority arising under a pilot scheme if the Primary Care Trust is providing any services under the pilot scheme.]]

(2)The Secretary of State may by order make provision for any rights and liabilities arising under pilot schemes under which personal medical services are provided to be transferred from [F36Strategic Health Authorities] to Primary Care Trusts and from Primary Care Trusts to [F36Strategic Health Authorities].

(3)Subsection (2) is without prejudice to any other power of the Secretary of State to transfer rights and liabilities under the 1977 Act.

GeneralU.K.

9 Relationship between this Part and the 1977 Act.E+W+S

(1)The provisions of the 1977 Act, apart from section [F3716D] (power of Secretary of State to direct a Health Authority to exercise [F37his functions]), apply in relation to functions of the Secretary of State under this Part (exercisable in relation to England and Wales) as if they were functions of his under Part I of the 1977 Act.

[F38(1A)In subsection (1), the words from “, apart from” to “functions),” have effect only in relation to Wales.]

(2)The 1977 Act (and in particular section 17) has effect in relation to piloted services—

(a)subject to any provision of, or made under, this Part; but

(b)otherwise as if those services were provided as a result of the delegation by the Secretary of State (by directions given under section [F3916D] of the 1977 Act) of functions of his under Part I of that Act.

(3)The functions of a Health Authority in relation to piloted services are primary functions of the Authority for the purposes of the M4National Health Service and Community Care Act 1990.

10 Relationship between this Part and the 1978 Act.E+W+S

(1)The provisions of the 1978 Act apply in relation to functions of the Secretary of State under this Part (exercisable in relation to Scotland) as if they were functions of his under Part I of the 1978 Act.

(2)The 1978 Act (and in particular section 2) has effect in relation to piloted services—

(a)subject to any provision of, or made under, this Part; but

(b)otherwise as if those services were provided as a result of the delegation by the Secretary of State (by regulations made or directions given under section 2 of the 1978 Act) of functions of his under that Act.

11 Medical practitioners to be suitably experienced.E+W+S

[F40(1)Any medical practitioner who performs personal medical services in connection with the provision of such services under a pilot scheme must be suitably experienced.

(2)Subsection (1) does not prevent the performance of personal medical services by—

(a)a person who is acting in the course of acquiring the experience prescribed by regulations made under section 32 of the 1977 Act or section 22 of the 1978 Act;

(b)a person who is provisionally registered under section 15 or 21 of the M5Medical Act 1983, acting in the course of his employment in a resident medical capacity in an approved medical practice (within the meaning of section 11(4) of that Act); or

(c)such other category of person as may be prescribed.

(3)Sections 31(2) and 32 of the 1977 Act (meaning of “suitably experienced”) apply for the purposes of this section as they apply for the purposes of section 31 of that Act.

(4)In its application by virtue of subsection (3), section 32 of the 1977 Act is to be read as if references to the applicant were references to a medical practitioner who is proposing to perform personal medical services in connection with the provision of such services under a pilot scheme.

(5)Sections 21(2) and 22 of the 1978 Act (meaning of “suitably experienced”) apply for the purposes of this section as they apply for the purposes of section 21 of that Act.

(6)In its application by virtue of subsection (5), section 22(2) of the 1978 Act is to be read as if references to the applicant were references to a medical practitioner who is proposing to perform personal medical services in connection with the provision of such services under a pilot scheme.]

12 Leaving medical lists.E+W+S

[F40(1)Except in such circumstances and to such extent as may be prescribed, a medical practitioner who performs personal medical services in connection with the provision of such services under a pilot scheme may not provide general medical services under Part II of the 1977 Act or Part II of the 1978 Act.

(2)Except in such circumstances as may be prescribed, [F41a Primary Care Trust, Health Authority or Health Board] must remove from their medical list the name of any medical practitioner who is performing personal medical services in connection with the provision of such services under a pilot scheme made [F42by any authority].]

13 Preferential treatment on transferring to medical lists.E+W+S

[F40(1)Before the Secretary of State approves a pilot scheme, he must determine whether a participating medical practitioner is to be given preferential treatment under Schedule 1 if he makes an application for his name to be included in [F43the medical list of the relevant body] after ceasing to perform personal medical services under the scheme.

F44[(1A)For the purposes of this section—

(a)where the authority concerned is a Health Authority or a Health Board, the relevant body is that Authority or Board;

(b)where the authority concerned is a Strategic Health Authority, the relevant body is the Primary Care Trust designated in relation to the pilot scheme by the Secretary of State.]

(2)Before a pilot scheme is varied so as to permit a new medical practitioner to perform personal medical services under the scheme, the Secretary of State must make a determination under this section in relation to the new practitioner.

(3)The Secretary of State may at any time make a determination under this section varying a determination about a medical practitioner if he is asked to do so by the practitioner concerned.

(4)Before making any determination under this section, the Secretary of State must publish the criteria by reference to which he will make it.

(5)Those criteria may be—

(a)criteria applying generally to all determinations;

(b)criteria applying only to the pilot scheme in question; or

(c)a mixture of both.

(6)The Secretary of State must notify the [F45relevant body] and the medical practitioner or practitioners concerned in writing of any determination made by him under this section.

(7)Different determinations may be made with respect to different medical practitioners performing personal medical services under the same pilot scheme.

(8)A determination may identify the medical practitioner or practitioners to which it applies by name or in any other way.

(9)Schedule 1 has effect in relation to preferential treatment for medical practitioners who wish to transfer to medical lists.]

F4614. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E+W+S

15 Liabilities and obligations in relation to deputies.E+W+S

[F47(1)Regulations may make provision with respect to the liabilities and obligations of—

(a)a Part II practitioner who, in connection with any obligation of his to provide general medical services, enters into arrangements under which a pilot scheme practitioner deputises, or is engaged to deputise, for him; or

(b)a Part II practitioner who enters into arrangements under which he deputises, or is engaged to deputise, for a pilot scheme practitioner, in connection with that practitioner’s obligation to perform personal medical services under a pilot scheme.

(2)The regulations may, in particular—

(a)modify any liabilities or obligations which would otherwise be applicable by virtue of Part II of the 1977 Act or Part II of the 1978 Act;

(b)apply (with or without modifications) any provision made by or under Part II of the 1977 Act or Part II of the 1978 Act (including any provision so made by virtue of section 17 of the M6Health and Medicines Act 1988).

(3)In this section—

• “Part II practitioner” means a medical practitioner who provides general medical services; and

• “pilot scheme practitioner” means a medical practitioner who performs personal medical services under a pilot scheme.]

16 NHS contracts.E+W+S

(1)In the case of a pilot scheme entered into, or to be entered into, by a single individual or body corporate, that individual or body may make an application under this section to become a health service body.

(2)In the case of any other pilot scheme, all of those providing, or proposing to provide, piloted services under the scheme may together make an application under this section to become a single health service body.

(3)An application must—

(a)be made to the Secretary of State in accordance with such provisions as may be prescribed; and

(b)specify the pilot scheme in relation to which it is made.

(4)Except in such cases as may be prescribed, the Secretary of State may grant an application.

(5)If an application is granted, the Secretary of State must specify when it is to come into effect and, as from that time—

(a)in the case of an application under subsection (1), the applicant is, and

(b)in the case of an application under subsection (2), the applicants together are,

a health service body for the purposes of section 4 of the M7National Health Service and Community Care Act 1990 and section 17A of the 1978 Act (NHS contracts).

(6)Those sections have effect in relation to such a health service body (“a pilot scheme health service body”), acting as acquirer, as if the functions referred to in subsection (1) of those sections were the provision of piloted services.

(7)Except in such circumstances as may be prescribed, a pilot scheme health service body resulting from an application under subsection (2) is to be treated, at any time, as consisting of those providing piloted services under the scheme.

(8)A direction as to payment made under section 4(7) of the Act of 1990 or section 17A(8) of the 1978 Act against, or in favour of, a pilot scheme health service body is enforceable—

(a)in England and Wales, in a county court (if the court so orders) as if it were a judgment or order of that court; and

(b)in Scotland, in like manner as an extract registered decree arbitral bearing warrant for execution issued by the sheriff court of any sheriffdom in Scotland.

(9)Regulations may provide for a pilot scheme health service body to cease to be such a body in prescribed circumstances.

(10)The Secretary of State must—

(a)maintain and publish a list of pilot scheme health service bodies;

(b)publish a revised copy of the list as soon as is reasonably practicable after any change is made to it.

(11)The list is to be published in such manner as the Secretary of State considers appropriate.

17 The Dental Practice Boards.E+W+S

(1)Regulations may confer such powers or impose such duties on the Board, in relation to pilot schemes under which personal dental services are provided, as may be prescribed.

(2)The regulations may, in particular, make any of the following kinds of provision.

(3)They may authorise or require the Board—

(a)to perform on behalf of an authority functions of a prescribed description (including functions relating to remuneration) which have been delegated to the Board by the authority in accordance with a power conferred by the regulations;

(b)to conduct or commission surveys or other research;

(c)to carry on such other activities as may be prescribed.

(4)They may provide that functions conferred by the regulations are only to be exercised by the Board in accordance with directions of the Secretary of State.

(5)They may enable the Board to direct a dental practitioner to submit to the Board, in relation to treatment or a description of treatment that he has carried out or contemplates carrying out, such information (including estimates, radiographs, models and other items) as may be prescribed.

(6)In this section “the Board” means—

(a)in relation to England and Wales, the Dental Practice Board; and

(b)in relation to Scotland, the Scottish Dental Practice Board.

Financial provisionsU.K.

18 Funding of preparatory work.E+W+S

(1)Provision may be made by regulations for authorities to make payments of financial assistance for preparatory work.

(2)“Preparatory work” means work which it is reasonable for a person to undertake—

(a)in connection with preparing proposals for a pilot scheme; or

(b)in preparing for the provision by him of any piloted services.

(3)Regulations under this section may, in particular, include provision—

(a)prescribing the circumstances in which payments of financial assistance may be made;

(b)imposing a limit on the amount of any payment of financial assistance which an authority may make in any prescribed period in respect of any one person or any one pilot scheme;

(c)imposing a limit on the aggregate amount which an authority may pay by way of financial assistance in any one financial year;

(d)requiring a person to whom assistance is given under this section to comply with such conditions as may be imposed in accordance with prescribed requirements; and

(e)for repayment in the case of a failure to comply with any condition so imposed.

F4819. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E+W+S

. . . . . . . . . . .

20 Charges for dental treatment.E+W+S

(1)Regulations may provide for the making and recovery, in such manner as may be prescribed, of charges for [F49dental treatment provided in accordance with pilot schemes.] [F49personal dental services provided in accordance with pilot schemes except—

(a)those services to which section 78(1A) of the 1977 Act or (as the case may be) section 70(1A) of the 1978 Act applies; and

(b)oral health assessments and dental examinations carried out on or after 1st April 2006.]

(2)[F50“Dental treatment” means personal dental services other than those to which section 78(1A) of the 1977 Act or (as the case may be) section 70(1A) of the 1978 Act applies.]

(3)The regulations must secure that the amount charged for a particular treatment (or course of treatment) is the same as the amount that would be charged for that treatment (or course of treatment) if it were provided under Part II of the 1977 Act or (as the case may be) Part II of the 1978 Act.

(4)The regulations may—

(a)provide for the amount or the maximum amount of any charge authorised by the regulations to be varied in prescribed circumstances; or

(b)give power to direct that the charge is not to be payable.

(5)If, under a contract or arrangement, a patient receives—

(a)services for which a charge is payable under section 78 of the 1977 Act or (as the case may be) section 70 of the 1978 Act, and

(b)treatment for which a charge is payable under the regulations,

the total charge for those services and that treatment is not to exceed such sum as may be prescribed.

(6)No charge is to be made under the regulations in respect of treatment provided for any person who, at the time of the making of the contract or arrangement under which the treatment is provided—

(a)was under 18;

(b)was under 19 and receiving qualifying full-time education;

(c)was pregnant; or

(d)had given birth within the previous twelve months.

(7)In subsection (6)(b) “qualifying full-time education” has the same meaning as in Schedule 12 to the 1977 Act or (as the case may be) in Schedule 11 to the 1978 Act.

(8)The regulations may provide, with respect to any exemption under subsection (6), that it is to be a condition of the exemption that—

(a)a declaration of the prescribed kind is made in the prescribed form or manner; or

(b)a certificate of the prescribed kind is supplied in the prescribed form or manner.]]

Part IIU.K. Primary Care

Personal medical or dental servicesU.K.

21 Provision of personal medical or dental services.U.K.

(1)In the 1977 Act, after section 28B, insert—

“ Provision of personal medical or dental servicesU.K.

28C Personal medical or dental services.

(1)A [F51Strategic Health Authority or a]Health Authority may make one or more agreements with respect to their area, in accordance with the provisions of regulations under section 28E, under which—

(a)personal medical services are provided (otherwise than by the Authority); or

(b)personal dental services are provided (otherwise than by the Authority).

(2)An agreement made under this section—

(a)may not combine arrangements for the provision of personal medical services with arrangements for the provision of personal dental services [F52, and may not combine arrangements for the provision of personal medical services or personal dental services with arrangements for the provision of local pharmaceutical services under LPS schemes (within the meaning of paragraph 1(3) of Schedule 8A to this Act) or under pilot schemes made under section 28 of the Health and Social Care Act 2001]; but

(b)may include arrangements for the provision of services—

(i)which are not personal medical services or personal dental services; but

(ii)which may be provided under this Part.

(3)Except to such extent as may be prescribed—

(a)a patient for whom personal medical services are provided in accordance with an agreement made under this section is not to count as a person for whom arrangements must be made by the [F53Primary Care Trust or]Health Authority concerned under section 29;

(b)a patient for whom personal dental services are provided under an agreement made under this section is not to count as a person for whom arrangements must be made by the [F53Primary Care Trust or] Health Authority concerned under section 35.

(4)This Act (and in particular section 17) has effect, in relation to personal medical services or personal dental services provided under an agreement made under this section, as if those services were provided as a result of the delegation by the Secretary of State (by directions given under section 13) of functions of his under this Part.

(5)The functions of a Health Authority in relation to an agreement made under this section are primary functions of the Authority for the purposes of the M8National Health Service and Community Care Act 1990.

(6)Regulations may provide—

(a)for functions which are exercisable by a [F54Strategic Health Authority or a]Health Authority in relation to an agreement made under this section to be exercisable on behalf of the 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 M9National Health Service (Scotland) Act 1978 to be exercisable on behalf of the Board by a [Strategic Health Authority or a]Health Authority.

(7)For the purposes of this section—

• “personal medical services” means medical services of a kind that may be provided by a general medical practitioner in accordance with arrangements made under Part II; and

• “personal dental services” means dental services of a kind that may be provided by a general dental practitioner in accordance with arrangements made under Part II.

28D Persons with whom agreements may be made.

(1)A [F55Strategic Health Authority or a] Health Authority may make an agreement under section 28C only with one or more of the following—

(a)an NHS trust;

(b)in the case of an agreement under which personal medical services are provided—

(i)a qualifying medical practitioner;

(ii)an individual who is providing personal medical services in accordance with section 28C arrangements or section 17C arrangements;

(c)in the case of an agreement under which personal dental services are provided—

(i)a qualifying dental practitioner;

(ii)an individual who is providing personal dental services in accordance with section 28C arrangements or section 17C arrangements;

(d)an NHS employee, a section 28C employee or a section 17C employee;

(e)a qualifying body.

(2)In this section—

• “the 1978 Act” means the M10National Health Service (Scotland) Act 1978;

• “NHS employee” means an individual who, in connection with the provision of services in the health service in England and Wales or Scotland, is employed by—

  (a)

  an NHS trust;

  (b)

  in the case of an agreement under which personal medical services are provided—

  (i)

  a medical practitioner whose name is included in a medical list kept under this Act or in a corresponding list kept under the 1978 Act; or

  (ii)

  a medical practitioner who is providing personal medical services in accordance with section 28C arrangements or section 17C arrangements;

  (c)

  in the case of an agreement under which personal dental services are provided—

  (i)

  a dental practitioner whose name is included in a list prepared in accordance with regulations made under section 36(1)(a) of this Act or section 25(2)(a) of the 1978 Act; or

  (ii)

  a dental practitioner who is providing personal dental services in accordance with section 28C arrangements or section 17C arrangements;

• “qualifying body” means—

  (a)

  a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraphs (a) to (d) of subsection (1); and also

  (b)

  in the case of an agreement under which personal dental services are provided, a body corporate which, in accordance with the provisions of Part IV of the M11Dentists Act 1984, is entitled to carry on the business of dentistry;

• “qualifying dental practitioner” means a dental practitioner who satisfies the conditions imposed by regulations made under section 28E(2)(b) of this Act or section 17E(2)(b) of the 1978 Act;

• “qualifying medical practitioner” means a medical practitioner who satisfies the conditions imposed by regulations made under section 28E(2)(b) of this Act or section 17E(2)(b) of the 1978 Act;

• “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 employed by an individual providing those services;

• “section 28C arrangements” means arrangements for the provision of services made under section 28C; and

• “section 28C employee” means an individual who, in connection with the provision of services in accordance with section 28C arrangements, is employed by an individual providing those services.”

(2)In the 1978 Act, after section 17B, insert—

“ Provision of personal medical or dental servicesU.K.

17C Personal medical or dental services.

(1)A Health Board may make one or more agreements with respect to their area, in accordance with the provisions of regulations under section 17E, under which—

(a)personal medical services are provided (otherwise than by the Board); or

(b)personal dental services are provided (otherwise than by the Board).

(2)An agreement made under this section—

(a)may not combine arrangements for the provision of personal medical services with arrangements for the provision of personal dental services; but

(b)may include arrangements for the provision of services—

(i)which are not personal medical services or personal dental services; but

(ii)which may be provided under this Part.

(3)Except to such extent as may be prescribed—

(a)a patient for whom personal medical services are provided in accordance with an agreement made under this section is not to count as a person for whom arrangements must be made by the Health Board concerned under section 19;

(b)a patient for whom personal dental services are provided under an agreement made under this section is not to count as a person for whom arrangements must be made by the Health Board concerned under section 25.

(4)This Act (and in particular section 2) has effect, in relation to personal medical services or personal dental services provided under an agreement made under this section, as if those services were provided as a result of the delegation by the Secretary of State (by directions given under section 2) of functions of his under this Part.

(5)Regulations may provide—

(a)for functions which are exercisable by a Health Board in relation to an agreement made under this section to be exercisable on behalf of the Board by a Health Authority; and

(b)for functions which are exercisable by a Health Authority in relation to an agreement made under section 28C of the M12National Health Service Act 1977 to be exercisable on behalf of the Authority by a Health Board.

(6)For the purposes of this section—

• “Health Authority” has the same meaning as in the National Health Service Act 1977;

• “personal medical services” means medical services of a kind that may be provided by a general medical practitioner in accordance with arrangements made under Part II; and

• “personal dental services” means dental services of a kind that may be provided by a general dental practitioner in accordance with arrangements made under Part II.

17D Persons with whom agreements may be made.

(1)A Health Board may make an agreement under section 17C only with one or more of the following—

(a)an NHS trust;

(b)in the case of an agreement under which personal medical services are provided—

(i)a qualifying medical practitioner;

(ii)an individual who is providing personal medical services in accordance with section 17C arrangements or section 28C arrangements;

(c)in the case of an agreement under which personal dental services are provided—

(i)a qualifying dental practitioner;

(ii)an individual who is providing personal dental services in accordance with section 17C arrangements or section 28C arrangements;

(d)an NHS employee, a section 17C employee or a section 28C employee;

(e)a qualifying body.

(2)In this section—

• “the 1977 Act” means the M13National Health Service Act 1977;

• “NHS employee” means an individual who, in connection with the provision of services in the health service in Scotland or England and Wales, is employed by—

  (a)

  an NHS trust;

  (b)

  in the case of an agreement under which personal medical services are provided—

  (i)

  a medical practitioner whose name is included in a medical list kept under this Act or in a corresponding list kept under the 1977 Act; or

  (ii)

  a medical practitioner who is providing personal medical services in accordance with section 17C arrangements or section 28C arrangements;

  (c)

  in the case of an agreement under which personal dental services are provided—

  (i)

  a dental practitioner whose name is included in a list prepared in accordance with regulations made under section 25(2)(a) of this Act or section 36(1)(a) of the 1977 Act; or

  (ii)

  a dental practitioner who is providing personal dental services in accordance with section 17C arrangements or section 28C arrangements;

• “qualifying body” means—

  (a)

  a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraphs (a) to (d) of subsection (1); and also

  (b)

  in the case of an agreement under which personal dental services are provided, a body corporate which, in accordance with the provisions of Part IV of the M14Dentists Act 1984, is entitled to carry on the business of dentistry;

• “qualifying dental practitioner” means a dental practitioner who satisfies the conditions imposed by regulations made under section 17E(2)(b) of this Act or section 28E(2)(b) of the 1977 Act;

• “qualifying medical practitioner” means a medical practitioner who satisfies the conditions imposed by regulations made under section 17E(2)(b) of this Act or section 28E(2)(b) of the 1977 Act;

• “section 17C employee” means an individual who, in connection with the provision of services in accordance with section 17C arrangements, is employed by an individual providing those services;

• “section 28C arrangements” means arrangements for the provision of services made under section 28C of the 1977 Act; and

• “section 28C employee” means an individual who, in connection with the provision of services in accordance with section 28C arrangements, is employed by an individual providing those services.”

(3)The Secretary of State may not make an order under section 41(3) bringing this section into force unless he is satisfied, having regard in particular to reviews of pilot schemes which have been conducted under section 7, that it would be in the interests of any part of the health service to bring this section into force.

22 Supplementary regulations.U.K.

(1)In the 1977 Act, after section 28D, insert—

“28E Personal medical or dental services: regulations.

(1)The Secretary of State may make regulations with respect to the provision of services in accordance with section 28C arrangements.

(2)The regulations must—

(a)include provision for participants other than [F56Strategic Health Authorities and] Health Authorities to withdraw from section 28C arrangements if they wish to do so;

(b)impose conditions (including conditions as to qualifications and experience) to be satisfied by medical practitioners performing personal medical services, and dental practitioners performing personal dental services, in accordance with section 28C arrangements.

In paragraph (b) “practitioner” does not include a practitioner who is undergoing training of a prescribed description.

(3)The regulations may, in particular—

(a)provide that section 28C arrangements may be made only in prescribed circumstances;

(b)provide that section 28C arrangements may be made only in prescribed areas;

(c)provide that only prescribed services, or prescribed categories of service, may be provided in accordance with section 28C arrangements;

(d)require details of section 28C arrangements to be published;

(e)make provision with respect to the variation and termination of section 28C arrangements;

(f)prevent (except in such circumstances and to such extent as may be prescribed) a medical practitioner who performs personal medical services in accordance with section 28C arrangements from providing general medical services;

(g)make provision with respect to medical lists, including provision for preferential treatment for medical practitioners;

(h)provide for parties to section 28C arrangements to be treated, in such circumstances and to such extent as may be prescribed, as health service bodies for the purposes of section 4 of the M15National Health Service and Community Care Act 1990;

(i)provide for directions, as to payments, made under section 4(7) of the Act of 1990 (as it has effect as a result of regulations made by virtue of paragraph (h)) to be enforceable in a county court (if the court so orders) as if they were judgments or orders of that court;

(j)confer powers or impose duties on the Dental Practice Board in relation to agreements made by virtue of section 28C(1) under which personal dental services are provided;

(k)authorise [F57Strategic Health Authorities and] Health Authorities to make payments of financial assistance for prescribed categories of preparatory work undertaken—

(i)in connection with preparing proposals for section 28C arrangements; or

(ii)in preparation for the provision of services under proposed section 28C arrangements.

(4)The regulations must include provision for a medical practitioner who—

(a)has provided or performed personal medical services in accordance with section 28C arrangements, and

(b)in contemplation of doing so, gave up fund-holding status,

to be allowed to return immediately to fund-holding status on satisfying the Secretary of State that, if he were granted that status, he would be able to fulfil the conditions for the time being in force for continuing to have it.

For the purposes of this subsection “fund-holding status” has such meaning as may be prescribed.

(5)The Secretary of State must—

(a)consider whether section 28C arrangements are likely to have an adverse effect on the distribution of medical practitioners providing general medical services or performing personal medical services in England or in Wales;

(b)if he thinks that the arrangements are likely to have that effect, consider whether it is necessary to include in the regulations provisions designed to secure that, so far as is possible, the arrangements do not have that effect; and

(c)if he thinks that it is necessary, include such provisions in the regulations.

(6)Regulations which impose conditions on persons performing personal medical services or persons performing personal dental services (whether made by virtue of subsection (2)(b) or otherwise) may, in particular, include provision of a kind that may be made by regulations under section 32.

(7)Regulations made by virtue of subsection (3)(g) may, in particular, include provision—

(a)requiring (except in prescribed circumstances) [F58Primary Care Trusts and] Health Authorities to remove from their medical lists persons who are performing personal medical services in accordance with section 28C arrangements or corresponding services under section 17C of the M16National Health Service (Scotland) Act 1978;

(b)conferring a right to transfer to a medical list on persons who have ceased to perform such services;

(c)that any provision in relation to medical lists made by or under any enactment is not to apply;

(d)as to conditions to be attached to entries in medical lists;

(e)conferring powers of disqualification on the [F59Family Health Services Appeal Authority constituted under section 49S].

(8)The power to make provision under this section of the kind mentioned in subsection (3)(j) includes power—

(a)to authorise or require the Dental Practice Board to perform on behalf of a [F60Strategic Health Authority or] Health Authority functions of a prescribed description (including functions relating to remuneration) which have been delegated to the Board by the [F60Strategic Health Authority or] Health Authority in accordance with a power conferred by the regulations;

(b)to provide that functions conferred by the regulations are only to be exercised by the Board in accordance with directions of the Secretary of State;

(c)to require information for the purpose of performing any functions conferred or imposed on the Board under this section.”

(2)In the 1978 Act, after section 17D, insert—

“17E Personal medical or dental services: regulations.

(1)The Secretary of State may make regulations with respect to the provision of services in accordance with section 17C arrangements.

(2)The regulations must—

(a)include provision for participants other than Health Boards to withdraw from section 17C arrangements if they wish to do so;

(b)impose conditions (including conditions as to qualifications and experience) to be satisfied by medical practitioners performing personal medical services, and dental practitioners performing personal dental services, in accordance with section 17C arrangements.

In paragraph (b) “practitioner” does not include a practitioner who is undergoing training of a prescribed description.

(3)The regulations may, in particular—

(a)provide that section 17C arrangements may be made only in prescribed circumstances;

(b)provide that section 17C arrangements may be made only in prescribed areas;

(c)provide that only prescribed services, or prescribed categories of service, may be provided in accordance with section 17C arrangements;

(d)require details of section 17C arrangements to be published;

(e)make provision with respect to the variation and termination of section 17C arrangements;

(f)prevent (except in such circumstances and to such extent as may be prescribed) a medical practitioner who performs personal medical services in accordance with section 17C arrangements from providing general medical services;

(g)make provision with respect to medical lists, including provision for preferential treatment for medical practitioners;

(h)provide for parties to section 17C arrangements to be treated, in such circumstances and to such extent as may be prescribed, as health service bodies for the purposes of section 17A;

(i)provide for directions, as to payments, made under section 17A(8) (as it has effect as a result of regulations made by virtue of paragraph (h)) to be enforceable in like manner as extract registered decrees arbitral bearing warrant for execution issued by the sheriff court of any sheriffdom in Scotland;

(j)confer powers or impose duties on the Dental Practice Board in relation to agreements made by virtue of section 17C(1) under which personal dental services are provided;

(k)authorise [Strategic Health Authorities and] Health Boards to make payments of financial assistance for prescribed categories of preparatory work undertaken—

(i)in connection with preparing proposals for section 17C arrangements; or

(ii)in preparation for the provision of services under proposed section 17C arrangements.

(4)The regulations must include provision for a medical practitioner who—

(a)has provided or performed personal medical services in accordance with section 17C arrangements, and

(b)in contemplation of doing so, gave up fund-holding status,

to be allowed to return immediately to fund-holding status on satisfying the Secretary of State that, if he were granted that status, he would be able to fulfil the conditions for the time being in force for continuing to have it.

For the purposes of this subsection “fund-holding status” has such meaning as may be prescribed.

(5)The Secretary of State must—

(a)consider whether section 17C arrangements are likely to have an adverse effect on the distribution of medical practitioners providing general medical services or performing personal medical services in Scotland;

(b)if he thinks that the arrangements are likely to have that effect, consider whether it is necessary to include in the regulations provisions designed to secure that, so far as is possible, the arrangements do not have that effect; and

(c)if he thinks that it is necessary, include such provisions in the regulations.

F61(6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(7)Regulations made by virtue of subsection (3)(g) may, in particular, include provision—

(a)requiring (except in prescribed circumstances) Health Boards to remove from their medical lists persons who are performing personal medical services in accordance with section 17C arrangements or corresponding services under section 28C of the M17National Health Service Act 1977;

(b)conferring a right to transfer to a medical list on persons who have ceased to perform such services;

(c)that any provision in relation to medical lists made by or under any enactment is not to apply;

(d)as to conditions to be attached to entries in medical lists;

(e)conferring powers of disqualification on the Tribunal constituted under section 29.

(8)The power to make provision under this section of the kind mentioned in subsection (3)(j) includes power—

(a)to authorise or require the Dental Practice Board to perform on behalf of a Health Board functions of a prescribed description (including functions relating to remuneration) which have been delegated to the Dental Practice Board by the Health Board in accordance with a power conferred by the regulations;

(b)to provide that functions conferred by the regulations are only to be exercised by the Dental Practice Board in accordance with directions of the Secretary of State;

(c)to require information for the purpose of performing any functions conferred or imposed on the Dental Practice Board under this section.

(9)In this Act “section 17C arrangements” means arrangements for the provision of services made under section 17C.”

23 Right to choose medical practitioner.E+W+S

F62(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F63(2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24 Right to choose dental practitioner.E+W+S

(1)In the 1977 Act, after section 28F, insert—

“28G Right to choose dental practitioner.

(1)Provision shall be made in regulations for conferring a right on any person to choose the dental practitioner from whom he is to receive primary dental services, subject to the consent of the practitioner concerned.

(2)The regulations shall, in particular, prescribe the procedure for choosing a practitioner.

(3)The regulations may, in particular, provide that the right to choose a dental practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.

(4)In this section “primary dental services” means dental services which are—

(a)provided, in accordance with section 28C arrangements, as personal dental services; or

(b)provided under Part II as general dental services.”

(2)In the 1978 Act, after section 17F, insert—

“17G Right to choose dental practitioner.

(1)Provision shall be made in regulations for conferring a right on any person to choose the dental practitioner from whom he is to receive primary dental services, subject to the consent of the practitioner concerned.

(2)The regulations shall, in particular, prescribe the procedure for choosing a practitioner.

(3)The regulations may, in particular, provide that the right to choose a dental practitioner conferred by the regulations shall, in the case of such persons as may be specified in the regulations, be exercised on their behalf by other persons so specified.

(4)In this section “primary dental services” means dental services which are—

(a)provided, in accordance with section 17C arrangements, as personal dental services; or

(b)provided under Part II as general dental services.”

25 Liabilities and obligations in relation to deputies.U.K.

F64(1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(2)In the 1978 Act, after section 24, insert—

“24A Liabilities and obligations in relation to deputies.

(1)Regulations may make provision with respect to the liabilities and obligations of—

(a)a Part II practitioner who, in connection with any obligation of his to provide general medical services, enters into arrangements under which a Part I practitioner deputises, or is engaged to deputise, for him; or

(b)a Part II practitioner who enters into arrangements under which he deputises, or is engaged to deputise, for a Part I practitioner, in connection with that practitioner’s obligation to perform personal medical services in accordance with section 17C arrangements.

(2)The regulations may, in particular—

(a)modify any liabilities or obligations which would otherwise be applicable by virtue of this Part;

(b)apply (with or without modifications) any provision made by or under this Part (including any provision so made by virtue of section 17 of the M18Health and Medicines Act 1988).

(3)In subsection (1)—

• “Part I practitioner” means a medical practitioner who performs personal medical services in accordance with section 17C arrangements; and

• “Part II practitioner” means a medical practitioner who provides general medical services.”

Pharmaceutical servicesU.K.

27 Provision of additional pharmaceutical services.E+W+S

(1)In the 1977 Act, after section 41, insert—

“41A Arrangements for providing additional pharmaceutical services.

(1)The Secretary of State may—

(a)give directions to a Health Authority requiring them to arrange for the provision to persons in their area of additional pharmaceutical services; or

(b)by giving directions to a Health Authority authorise them to arrange for such provision if they wish to do so.

(2)Directions under this section may make different provision in relation to different services specified in the directions.

(3)The Secretary of State must publish any directions under this section in the Drug Tariff or in such other manner as he thinks appropriate.

(4)In this section—

• “additional pharmaceutical services”, in relation to directions, means such services (of a kind that do not fall within section 41) as may be specified in the directions; and

• “Drug Tariff” means the Drug Tariff published under regulation 18 of the M19National Health Service (Pharmaceutical Services) Regulations 1992 or under any corresponding provision replacing, or otherwise derived from, that regulation.”

(2)In the 1978 Act, after section 27, insert—

“27A Arrangements for providing additional pharmaceutical services.

(1)The Secretary of State may—

(a)give directions to a Health Board requiring them to arrange for the provision to persons in their area of additional pharmaceutical services; or

(b)by giving directions to a Health Board authorise them to arrange for such provision if they wish to do so.

(2)Directions under this section may make different provision in relation to different services specified in the directions.

(3)The Secretary of State must publish any directions under this section in the Drug Tariff or in such other manner as he thinks appropriate.

(4)In this section—

• “additional pharmaceutical services”, in relation to directions, means such services (of a kind that do not fall within section 27) as may be specified in the directions; and

• “Drug Tariff” means the Drug Tariff published under regulation 9 of the M20National Health Service (Pharmaceutical Services) (Scotland) Regulations 1995 or under any corresponding provision replacing, or otherwise derived from, that regulation.”

28 Terms and conditions etc.E+W+S

(1)In the 1977 Act, after section 41A, insert—

“41B Terms and conditions etc.

(1)Directions under section 41A may require the Health Authority to whom they apply, when making arrangements—

(a)to include, in the terms on which the arrangements are made, such terms as may be specified in the directions;

(b)to impose, on any person providing a service in accordance with the arrangements, such conditions as may be so specified.

(2)The arrangements must secure that any service to which they apply is provided only by a person whose name is included in a pharmaceutical list.

(3)Different arrangements may be made with respect to—

(a)the provision of the same service by the same person but in different circumstances; or

(b)the provision of the same service by different persons.

(4)A Health Authority must provide details of proposed arrangements (including the remuneration to be offered for the provision of services) to any person who asks for them.

(5)After making any arrangements, a Health Authority must publish, in such manner as the Secretary of State may direct, such details of the arrangements as he may direct.

(6)In this section, “pharmaceutical list” means, subject to any provision of the directions in question, a list—

(a)published by the Health Authority concerned, or by any other Health Authority, in accordance with regulations made under section 42(2)(a) of this Act; or

(b)published by any body in accordance with regulations made under section 27(2)(a) of the M21National Health Service (Scotland) Act 1978 or Article 63(2A)(a) of the M22Health and Personal Social Services (Northern Ireland) Order 1972.”

(2)In the 1978 Act, after section 27A, insert—

“27B Terms and conditions etc.

(1)Directions under section 27A may require the Health Board to whom they apply, when making arrangements—

(a)to include, in the terms on which the arrangements are made, such terms as may be specified in the directions;

(b)to impose, on any person providing a service in accordance with the arrangements, such conditions as may be so specified.

(2)The arrangements must secure that any service to which they apply is provided only by a person whose name is included in a pharmaceutical list.

(3)Different arrangements may be made with respect to—

(a)the provision of the same service by the same person but in different circumstances; or

(b)the provision of the same service by different persons.

(4)A Health Board must provide details of proposed arrangements (including the remuneration to be offered for the provision of services) to any person who asks for them.

(5)After making any arrangements, a Health Board must publish, in such manner as the Secretary of State may direct, such details of the arrangements as he may direct.

(6)In this section, “pharmaceutical list” means, subject to any provision of the directions in question, a list—

(a)published by the Health Board concerned, or by any other Health Board, in accordance with regulations made under section 27(2) of this Act; or

(b)published by any body in accordance with regulations made under section 42(2) of the M23National Health Service Act 1977 or Article 63(2A)(a) of the M24Health and Personal Social Services (Northern Ireland) Order 1972.”

29 Authorised provision of pharmaceutical services by medical practitioners.E+W+S

(1)In section 43 of the 1977 Act, after subsection (2), insert—

“(2A)Regulations shall provide for the preparation and publication by a Health Authority of one or more lists of medical practitioners who undertake to provide drugs, medicines or listed appliances in the Authority’s area.

(2B)In subsection (2A) “listed” has the same meaning as in section 41.

(2C)The regulations shall include provision for the removal of an entry from a list in prescribed circumstances.”

(2)In section 28 of the 1978 Act, after subsection (2), insert—

“(2A)Regulations shall provide for the preparation and publication by a Health Board of one or more lists of medical practitioners who undertake to supply drugs and appliances in the Board’s area.

(2B)The regulations shall include provision for the removal of an entry from a list in prescribed circumstances.”

Ophthalmic servicesU.K.

30 Duty of registered opticians to refer certain persons to registered medical practitioners.E+W+S

(1)Section 31 of the M25Opticians Act 1989 (matters with respect to which the General Optical Council may make rules) is amended as follows.

(2)In subsection (5) (power to make rules requiring registered optician to refer persons to registered medical practitioners except in certain circumstances), for the words from “except” to “take the prescribed steps” substitute “except—

(a)in an emergency,

(b)where that person is consulting him for the purpose of being given treatment in accordance with rules under subsection (l)(d) above, or

(c)in such other cases as may be prescribed,

take the prescribed steps ”.

(3)After subsection (5), insert—

“(5A)Rules made by virtue of subsection (5)(c) may impose conditions which must be satisfied if the exception for which those rules provide is to apply.”

NHS contractsE+W+S

31 Provision of certain services under NHS contracts.E+W+S

(1)In the M26National Health Service and Community Care Act 1990, after section 4 (NHS contracts), insert—

“4A Provision of certain services under NHS contracts.

(1)This section applies to any arrangement under which a Health Authority or such other health service body as may be prescribed arrange for the provision to them—

(a)by a person on an ophthalmic list, or

(b)by a person on a pharmaceutical list,

of goods or services that they reasonably require for the purposes of functions which they are exercising under Part I of the principal Act.

(2)Any such arrangement is to be treated as an NHS contract for the purposes of section 4 (other than subsections (4) and (6)).

(3)In this section—

• “health service body” means a body which is a health service body for the purposes of section 4;

• “ophthalmic list” means a list published in accordance with regulations made under—

  (a)

  section 39(a) of the principal Act;

  (b)

  section 26(2)(a) of the M27National Health Service (Scotland) Act 1978; or

  (c)

  Article 62(2)(a) of the M28Health and Personal Social Services (Northern Ireland) Order 1972; and

• “pharmaceutical list” means a list published in accordance with regulations made under—

  (a)

  section 42(2)(a) of the principal Act;

  (b)

  section 27(2) of the National Health Service (Scotland) Act 1978; or

  (c)

  Article 63(2A)(a) of the 1972 Order.”

(2)In the 1978 Act, after section 17, insert—

“ NHS contractsE+W+S

17AA Provision of certain services under NHS contracts.

(1)This section applies to any arrangement under which a Health Board or such other health service body as may be prescribed arrange for the provision to them—

(a)by a person on an ophthalmic list, or

(b)by a person on a pharmaceutical list,

of goods or services that they reasonably require for the purposes of functions which they are exercising under Part I of this Act.

(2)Any such arrangement is to be treated as an NHS contract for the purposes of section 17A (other than subsections (5) and (7)).

(3)In this section—

• “health service body” means a person or body which is a health service body for the purposes of section 17A;

• “ophthalmic list” means a list published in accordance with regulations made under—

  (a)

  section 26(2)(a) of this Act;

  (b)

  section 39(a) of the M29National Health Service Act 1977; or

  (c)

  Article 62(2)(a) of the M30Health and Personal Social Services (Northern Ireland) Order 1972; and

• “pharmaceutical list” means a list published in accordance with regulations made under—

  (a)

  section 27(2) of this Act;

  (b)

  section 42(2)(a) of the National Health Service Act 1977; or

  (c)

  Article 63(2A)(a) of the 1972 Order.”

Medical lists and vacanciesU.K.

F6632 Medical lists and vacancies: England and Wales.E+W+S

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical practicesU.K.

34 Sale of medical practices.E+W+S

(1)In the 1977 Act, for section 54 (sale of medical practices), substitute—

“54 Sale of medical practices.

(1)It is unlawful to sell the goodwill of the medical practice of a person who has at any time—

(a)provided general medical services under arrangements made with any Council, Committee or Authority under the M31National Health Service Act 1946, the M32National Health Service Reorganisation Act 1973 or this Act, or

(b)provided or performed personal medical services in accordance with section 28C arrangements,

unless that person no longer provides or performs such services and has never carried on the practice in a relevant area.

(2)In this section—

• “goodwill” includes any part of goodwill and, in relation to a person practising in partnership, means his share of the goodwill of the partnership practice;

• “medical practice” includes any part of a medical practice; and

• “relevant area”, in relation to any Council, Committee or Authority by arrangement with whom a person has at any time—

  (a)

  provided general medical services, or

  (b)

  provided or performed personal medical services in accordance with section 28C arrangements,

  means the area, district or locality of that Council, Committee or Authority (at that time).

(3)Schedule 10 supplements the provisions of this section.”

(2)In the 1978 Act, for section 35 (sale of medical practices), substitute—

“35 Sale of medical practices.

(1)It is unlawful to sell the goodwill of the medical practice of a person who has at any time—

(a)provided general medical services under arrangements made with any Executive Council or Health Board under the M33National Health Service (Scotland) Act 1947, the M34National Health Service (Scotland) Act 1972 or this Act, or

(b)provided or performed personal medical services in accordance with section 17C arrangements,

unless that person no longer provides or performs such services and has never carried on the practice in a relevant area.

(2)In this section—

• “goodwill” includes any part of goodwill and, in relation to a person practising in partnership, means his share of the goodwill of the partnership practice;

• “medical practice” includes any part of a medical practice; and

• “relevant area”, in relation to any Executive Council or Health Board by arrangement with whom a person has at any time—

  (a)

  provided general medical services, or

  (b)

  provided or performed personal medical services in accordance with section 17C arrangements,

  means the area of that Council or Board (at that time).

(3)Schedule 9 supplements the provisions of this section.”

35 Employment of pre-registration house officers in medical practices.E+W+S

(1)The M35Medical Act 1983 is amended as follows.

(2)In subsection (2) of section 10 (experience required for full registration as a medical practitioner), for “approved hospitals or approved institutions,” substitute “—

(a)approved hospitals,

(b)approved institutions, or

(c)approved medical practices,”.

(3)In subsection (3) of section 11 (construction of section 10, etc), after the first “where” insert “—

(a)in the case of an approved hospital or an approved institution,”, and at the end insert

“; or

(b)in the case of an approved medical practice, the person employed satisfies such conditions as to residence as may be prescribed”.

(4)In subsection (4) of section 11—

(a)insert in the appropriate place—

““medical practice” means a prescribed description of practice in which one or more medical practitioners—

(a)provide general medical services under Part II of the M36National Health Service Act 1977, Part II of the M37National Health Service (Scotland) Act 1978 or Part VI of the M38Health and Personal Social Services (Northern Ireland) Order 1972; or

(b)perform personal medical services in accordance with arrangements made under section 28C of the 1977 Act, section 17C of the 1978 Act or the corresponding provisions of the law in force in Northern Ireland;”;

(b)in the definition of “prescribed”, after “means” insert “—

(a)in subsection (3)(b) and in the definition of “medical practice”, prescribed by regulations made by the Secretary of State; and

(b)in the other provisions of this Part,”.

(5)After subsection (4) of section 11 insert—

“(4A)The Education Committee may by regulations provide that the period of employment in a medical practice which may be reckoned towards the completion of any of the periods mentioned in section 10(3)(a) above shall not exceed such period as may be specified in the regulations.”

(6)In subsection (5) of section 11, after “under subsection (2) of section 10 above” insert “ or under subsection (4A) of this section ”.

(7)After subsection (6) of section 11 insert—

“(7)Regulations made by the Secretary of State under this section must be made by statutory instrument; and such a statutory instrument shall be subject to annulment in pursuance of a resolution of either House of Parliament.”

Part IIIU.K. Miscellaneous and Supplemental

36 Expenditure of Health Authorities.E+W+S

In section 97 of the 1977 Act (expenditure of Health Authorities), for subsections (1) to (3) substitute—

“(1)It is the duty of the Secretary of State to pay to each Health Authority sums equal to their general Part II expenditure.

(2)“General Part II expenditure” is expenditure which—

(a)is attributable to the payment of remuneration to persons providing services in pursuance of Part II; but

(b)does not fall within paragraphs (b) to (d) of subsection (3A).

(3)It is the duty of the Secretary of State to pay to each Health Authority, in respect of each financial year, sums not exceeding the amount allotted for that year by the Secretary of State to the Authority towards meeting their main expenditure.

(3A)In subsection (3) “main expenditure” means expenditure which is attributable to—

(a)the performance by the Authority of their functions in that year, but—

(i)is not general Part II expenditure; and

(ii)does not fall within paragraphs (b) to (d);

(b)the reimbursement of expenses of persons providing services in pursuance of Part II which are designated expenses incurred in connection with the provision of the services (or in giving instruction in matters relating to the services);

(c)remuneration which is paid to persons providing additional pharmaceutical services (in accordance with directions under section 41A), in respect of such of those services as are designated; or

(d)remuneration which is—

(i)paid to persons providing general medical services under Part II;

(ii)determined by the Health Authority concerned; and

(iii)of a designated description.

(3B)In paragraph (b), (c) or (d) of subsection (3A), “designated” means designated in writing by the Secretary of State for the purposes of that paragraph and in relation to the allotment in question.”

37 Expenditure of Health Boards.E+W+S

(1)In section 85 of the 1978 Act (expenses of certain bodies), after subsection (1) insert—

“(1AA)Notwithstanding subsection (2), the amount allotted by the Secretary of State to a Health Board under subsection (1) shall include provision for expenditure of that Board which is attributable to—

(a)remuneration which is paid to persons providing additional pharmaceutical services (in accordance with directions under section 27A), in respect of such of those services as are designated; or

(b)remuneration which is—

(i)paid to persons providing general medical services under Part II;

(ii)determined by the Health Board concerned; and

(iii)of a designated description.

(1AB)In subsection (1AA), “designated” means designated in writing by the Secretary of State for the purposes of that subsection and in relation to the allotment in question.”

(2)In subsection (2) at the beginning insert “ Subject to subsection (1AA), ”.

38 Corresponding provision for Northern Ireland.U.K.

(1)An Order in Council under paragraph 1(1)(b) of Schedule 1 to the M39Northern Ireland Act 1974 (legislation for Northern Ireland in the interim period) which contains a statement that it is made only for purposes corresponding to purposes of any of the provisions of this Act—

(a)shall not be subject to paragraph 1(4) and (5) of that Schedule (affirmative resolution of both Houses of Parliament); but

(b)shall be subject to annulment in pursuance of a resolution of either House of Parliament.

(2)This section does not apply in relation to the provisions of sections 32 to 34.

39 Regulations and directions.E+W+S

(1)Any power under this Act to make regulations is exercisable by the Secretary of State.

(2)Any such power—

(a)may be exercised to make different provision for different cases or descriptions of case, including different provision for different areas; and

(b)includes power to make such incidental, supplemental, consequential or transitional provision as appears to the Secretary of State to be appropriate.

(3)Regulations under this Act must be made by statutory instrument.

(4)Such a statutory instrument shall be subject to annulment in pursuance of a resolution of either House of Parliament.

(5)Any power under or by virtue of this Act to give directions—

(a)is to be exercised by an instrument in writing; and

(b)includes power to vary or revoke the directions by subsequent directions.

(6)Subsection (2) applies in relation to any power of the Secretary of State under or by virtue of this Act to give directions as it applies in relation to any power of his to make regulations.

40 Interpretation.U.K.

(1)Subject to subsection (2), Part I—

(a)in its application to England and Wales, is to be read as one with the 1977 Act; and

(b)in its application to Scotland, is to be read as one with the 1978 Act.

(2)In this Act—

• “the 1977 Act” means the M40National Health Service Act 1977;

• “the 1978 Act” means the M41National Health Service (Scotland) Act 1978;

• “authority” has the meaning given by section 1(8) [F68, except in Schedule 1];

• “health service” means the health service in England and Wales and the health service in Scotland;

• [F69“medical list” has the meaning given by section 2(5);]

• [F69“personal medical services” and “personal dental services” have the meaning given in section 1(8);]

• “pilot scheme” and “piloted services” have the meaning given in section 1;

• “prescribed” means prescribed by regulations; and

• “regulations” means regulations under this Act.

F70(3). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

41 Short title, commencement and extent, etc.U.K.

(1)This Act may be referred to as the National Health Service (Primary Care) Act 1997.

(2)Sections 38 to 40 and subsections (1) to (9) and (13) and (14) of this section come into force on the passing of this Act.

(3)Otherwise, this Act comes into force on such date as may be appointed by order made by the Secretary of State; but different dates may be appointed for different provisions and for different purposes.

(4)Any such order may include such transitional provisions or savings as the Secretary of State considers appropriate.

(5)A Health Authority, Health Board or NHS trust is to be taken as having, at any time before the commencement of any provision of this Act, power to prepare for that commencement.

(6)Any amendment, repeal or revocation made by or under this Act has the same extent as the enactment or other instrument amended, repealed or revoked.

(7)Subject to subsection (6), only section 38 and this section (except subsections (5) and (8)) extend to Northern Ireland.

(8)The Secretary of State may by order provide that this Act extends to the Isles of Scilly with such modifications (if any) as are specified in the order; but otherwise this Act does not extend there.

(9)Orders under subsections (3), (8) and (13) must be made by statutory instrument.

(10)Part I of Schedule 2 makes minor and consequential amendments.

(11)Part II of Schedule 2 makes amendments to facilitate, or which are otherwise desirable in connection with, the consolidation of certain enactments relating to the health service.

(12)The repeals and revocations set out in Schedule 3 are to have effect.

(13)The Secretary of State may by order make such amendments or repeals of any enactment passed before, or in the same Session as, this Act as appear to him necessary or expedient in consequence of any provision of this Act.

(14)An order under subsection (13)—

(a)may contain such supplemental, incidental, consequential or transitional provisions and savings as the Secretary of State considers appropriate; and

(b)shall be subject to annulment in pursuance of a resolution of either House of Parliament.

SCHEDULES

Section 13(9).

F71SCHEDULE 1E+W+S Preferential Treatment on Transferring to Medical Lists

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section 41(10) and (11).

SCHEDULE 2U.K. Amendments

Part IU.K. Minor and Consequential Amendments

The Health Services and Public Health Act 1968 (c. 46)E+W+S

1(1)The Health Services and Public Health Act 1968 is amended as follows.E+W+S

(2)In section 59(1), for “general medical services or general dental services” substitute “ general medical services, personal medical services, general dental services or personal dental services ”.

(3)After section 59(2) insert—

“(2A)In subsection (1), references to personal medical services and personal dental services are to be construed as references to services of those respective kinds under section 28C of the 1977 Act, section 17C of the 1978 Act or the corresponding provisions of the law in force in Northern Ireland or the Isle of Man.”

(4)After section 63(2)(b) insert—

“(ba)the provision or performance of a service in accordance with arrangements made under section 28C of the 1977 Act or section 17C of the M42National Health Service (Scotland) Act 1978 and an activity involved in or connected with the provision or performance of such a service;”.

The Patents Act 1977 (c. 37)U.K.

2U.K.In section 56(4)(a) of the Patents Act 1977, for the words from “provision of” to “Isle of Man” substitute “provision of—

(i)pharmaceutical services, general medical services or general dental services under Part II of the M43National Health Service Act 1977, Part II of the National Health Service (Scotland) Act 1978, or the corresponding provisions of the law in force in Northern Ireland or the Isle of Man, or

(ii)personal medical services or personal dental services provided in accordance with arrangements made under section 28C of the 1977 Act, section 17C of the 1978 Act, or the corresponding provisions of the law in force in Northern Ireland or the Isle of Man”.

The National Health Service Act 1977 (c. 49)U.K.

3U.K.The 1977 Act is amended in accordance with paragraphs 4 to 31.

4(1)Section 15 is amended as follows.E+W+S

(2)After subsection (1) insert—

“(1ZA)It is the duty of each Health Authority, in accordance with regulations, to perform such functions in relation to section 28C arrangements as may be prescribed.

(1ZB)Regulations under subsection (1ZA) may, in particular—

(a)prescribe functions in relation to training;

(b)provide for appeals to the Secretary of State or a prescribed body in relation to functions prescribed by the regulations.”

F72[(3)For subsection (1B) substitute—

“(1B)In relation to a Part II medical practitioner—

(a)whose name is included in the medical list of only one Health Authority, and

(b)who practises on his own or in partnership with others all of whom are Part II medical practitioners whose names are included only in that Authority’s medical list,

any reference in this Act or the M44National Health Service and Community Care Act 1990 to the relevant Health Authority is to be construed as a reference to that Authority.

(1BA)In relation to a medical practitioner who is not within subsection (1B), any reference in this Act or the National Health Service and Community Care Act 1990 to the relevant Health Authority is to be construed as a reference to the Authority in whose area most of the practice patients live.”]

F72[(4)After subsection (1C) insert—

“(1D)In this section—

• “Part II medical practitioner” means a medical practitioner who provides general medical services under Part II and does not perform personal medical services under section 28C arrangements; and

• “practice patient” means—

  (a)

  in relation to a medical practitioner who practises otherwise than in partnership, an individual who is on that practitioner’s list of patients (or, if that practitioner and one or more other medical practitioners together have a single list of patients in connection with section 28C arrangements, an individual who is on that single list);

  (b)

  in relation to a medical practitioner who is one of two or more practitioners who practise in partnership with each other, an individual who is on the list of patients of any of those practitioners (or, if any of those practitioners together have a single list of patients in connection with section 28C arrangements, an individual who is on that single list).”]