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Statutory Instruments of the Scottish Parliament


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SCOTTISH STATUTORY INSTRUMENTS


2003 No. 64

NATIONAL HEALTH SERVICE

The National Health Service (General Medical Services Supplementary Lists) (Scotland) Regulations 2003

  Made 5th February 2003 
  Laid before the Scottish Parliament 6th February 2003 
  Coming into force in accordance with regulations 1(1) and (2)


ARRANGEMENT OF REGULATIONS

1. Citation, commencement and extent
2. Interpretation.
3. Supplementary lists.
4. Contents of supplementary lists.
5. Amendment of or withdrawal from supplementary list.
6. Removal from supplementary list of names of medical practitioners not providing services.
7. Removal from supplementary list on grounds of death etc.
8. Application for inclusion in supplementary list.
9. Consideration of applications.
10. Reinclusion in supplementary list.
11. Publication of particulars.
12. Arrangements for supply of drugs and appliances.
13. Payments.
14. Appeal to the Scottish Ministers.
15. Consequential amendments.

SCHEDULES

  1. Terms and conditions for medical practitioners included in supplementary list.

  2. Information and declarations to be included in an application for inclusion in a supplementary list.

The Scottish Ministers, in exercise of the powers conferred by sections 19, 24B, 24C(2) and 105(7) of the National Health Service (Scotland) Act 1978[
1] and of all other powers enabling them in that behalf, hereby make the following Regulations:

Citation, commencement and extent
     1.  - (1) These Regulations may be cited as the National Health Service (General Medical Services Supplementary Lists) (Scotland) Regulations 2003 and, subject to paragraph (2), come into force on 28th February 2003.

    (2) Regulation 15(b) will come into force on 1st August 2003.

    (3) These Regulations extend to Scotland only.

Interpretation
    
2. In these Regulations, unless the context otherwise requires-

Supplementary lists
     3. A medical practitioner whose name is included in a supplementary list shall comply with the terms and conditions for inclusion in a supplementary list set out in Schedule 1 to these Regulations.

Contents of supplementary lists
    
4.  - (1) Each Board shall prepare a supplementary list of all medical practitioners approved by it to assist in the provision of general medical services which it has arranged in accordance with section 19(1) of the Act.

    (2) A medical practitioner's name may be included in a supplementary list for the purpose of assisting in the provision of general medical services which may include either or both of the following:-

    (3) A supplementary list shall contain-

Amendment of or withdrawal from supplementary list
    
5.  - (1) A medical practitioner shall, unless it is impracticable to do so, give notice to the Board within 30 days of any occurrence requiring a change in the information recorded in the supplementary list.

    (2) A medical practitioner shall, unless it is impracticable to do so, give notice in writing to the Board at least 90 days in advance of any date on which the practitioner intends either-

    (3) Subject to paragraph (5) the Board shall-

    (4) Any notice pursuant to paragraph (2) may not be withdrawn except with the consent of the Board.

Removal from supplementary list of names of medical practitioners not providing services
    
6.  - (1) Where a Board, with a view to securing that arrangements are such that all persons in the area who avail themselves of general medical services receive adequate personal care and attendance, has determined in accordance with the provisions of this regulation that a medical practitioner whose name is included in a supplementary list has for the preceding 12 months not assisted in the provision of general medical services personally for persons in the area, it may, after giving 30 days' notice in writing of its intention to do so, remove the practitioner's name from such list, unless the Scottish Ministers direct to the contrary, in accordance with the following provisions.

    (2) In calculating the period of 12 months referred to in paragraph (1) the Board shall disregard any period during which the medical practitioner was suspended

    (3) If in the case of a medical practitioner whose name is included in the supplementary list-

the Board may after giving the medical practitioner 30 days' notice in writing of its intention to do so, remove his name from the supplementary list, unless the Scottish Ministers direct to the contrary, in accordance with the following provisions.

    (4) Before making any determination under paragraphs (1) or (3) the Board shall afford the medical practitioner an opportunity to make representations to it in writing or, if requested, orally, to a committee appointed by the Board for the purpose, of which committee at least one-third of the members shall be medical practitioners.

    (5) A medical practitioner to whom notice has been given under paragraphs (1) or (3) may within 21 days of receiving such notice appeal to the Scottish Ministers against the decision of the Board and, pending the decision on any such appeal, the Board shall not remove the practitioner's name from the list by reason of the determination against which appeal has been so lodged. The notice of appeal shall be in writing and shall set out the facts and contentions on which the practitioner intends to rely. If the Scottish Ministers allow the appeal, they shall direct the Board not to remove the name of the practitioner from the list by reason of the determination appealed against.

    (6) Nothing in this regulation shall affect a medical practitioner who is performing a period of relevant service and no determination under this regulation shall be made in respect of any such doctor until 6 months after he has completed the said relevant service.

Removal from supplementary list on grounds of death etc.
    
7. Where a Board determines that a medical practitioner whose name has been included in a supplementary list-

it shall remove the practitioner's name from the supplementary list with effect from the date of its determination or, in the case of (c) above, the date on which the direction or order takes effect, if that date is later than the date of the Board's determination.

Application for inclusion in supplementary list
    
8.  - (1) Application by a medical practitioner for inclusion in a supplementary list shall be made to the appropriate Board in writing and shall include the information and undertakings specified in Schedule 2 to these Regulations.

    (2) An application under this regulation by a medical practitioner who is a national of an EEA state shall be accompanied by evidence that the doctor has a knowledge of English which, in the interests of himself and his patients, is necessary for assisting in the provision of general medical services.

    (3) A medical practitioner may apply to be approved to assist in the provision of child health surveillance services or minor surgery services at the same time as the practitioner applies for inclusion in the supplementary list.

    (4) Where paragraph (3) applies the applicant shall provide-

    (5) A Board shall consider and determine an application to assist in the provision of any such services at the same time as it considers and determines an application under paragraph (1) and shall give reasons for its determination.

Consideration of applications
    
9.  - (1) Before determining an application in accordance with this regulation, a Board shall check, so far as practicable, the information provided by the applicant and any relevant documents.

    (2) A Board shall refuse to include the name of an applicant in its supplementary list if-

    (3) If a Board refuses to include an applicant's name in its list, it shall notify the applicant of its decision and the reasons for it (including any facts on which it has relied) and of any right of appeal under regulation 14.

    (4) A Board shall defer determination of an application for inclusion in a supplementary list-

and the Board shall notify the applicant of the deferral and its reasons in writing.

    (5) A Board shall defer a determination under paragraph (4) only until the outcome of the relevant event is known.

    (6) Once the outcome of the relevant event is known, the Board shall require the applicant to update the application within 28 days (or such longer period as the Board specifies) with any further relevant information and on the expiry of the relevant period shall again consider the application and notify the applicant of its determination and the reasons for it (including any facts relied on) and any right of appeal.

Reinclusion in supplementary list
    
10. Where a medical practitioner's name has been removed from a supplementary list on grounds of conviction of a criminal offence and that conviction is overturned on appeal, the Board may include that medical practitioner's name in its supplementary list without a full application being made in accordance with regulation 8 if it is satisfied that there are no other matters which it should consider and provided that it receives undertakings to comply with these Regulations.

Publication of particulars
    
11.  - (1) A Board shall make available for inspection at its office copies of-

and shall keep them up-to-date.

    (2) A Board may make either of the documents described in paragraph (1) available for inspection at such other places as appear convenient for informing all persons interested, or may publish at such places a notice of the places and times at which copies of any of those documents may be inspected.

    (3) Subject to paragraph (4), the Board shall-

    (4) If the Board considers that only parts of the medical list, or that only some alterations, are likely to concern the Area Medical and Pharmaceutical Committees or pharmacists, it may send to them a copy of those parts or alterations only.

Arrangements for supply of drugs and appliances
    
12. Where a Board has required a principal, in accordance with regulation 34 of the 1995 Regulations (arrangements for supply by doctors of drugs and appliances), to supply drugs and appliances to a person for whose treatment he is responsible, a medical practitioner who assists that principal in the supply of such drugs and appliances shall comply with any requirement imposed on the principal by the Board or by these Regulations.

Payments
    
13.  - (1) Where the Agency considers that-

the Board may draw the overpayment to the attention of that practitioner and invite that practitioner to make representations in relation to it or the assistance which that practitioner may have rendered.

    (2) Where the Board decide that there has been an overpayment for which the practitioner is responsible, in whole or in part, the amount overpaid or such part shall be recoverable from the practitioner as a debt.

Appeal to the Scottish Ministers
    
14.  - (1) A medical practitioner whose-

may appeal on a point of law to the Scottish Ministers.

    (2) A practitioner may appeal by sending to the Scottish Ministers a notice of appeal within 21 days, or within such longer period as the Scottish Ministers may for reasonable cause allow, of the date on which notice of the decision of the Board is given to that practitioner.

    (3) A notice of appeal shall contain a concise statement of the point or points of law in respect of which the practitioner contends that the decision of the Board is erroneous.

    (4) If it appears to the Scottish Ministers that the appeal is of such a nature that it can properly be determined without a hearing, they may determine the appeal summarily without a hearing and shall send their decision to the appellant and the Board.

    (5) If the Scottish Ministers are of the opinion that a hearing is required, they shall appoint-

to hear the appeal.

    (6) A hearing shall take place at such time and place as the Scottish Ministers may direct and notice of the hearing shall be sent by post to the appellant and the Board not less than 14 days before the date fixed for the hearing.

    (7) The appellant may attend and be heard in person or by counsel or solicitor or other representative and the Board may be represented at the hearing by any duly authorised member or official or by counsel or solicitor.

    (8) Subject to the provisions of this regulation, the procedure at the hearing shall be such as the person or persons hearing the appeal may determine.

    (9) The person or persons hearing the appeal shall report thereon to the Scottish Ministers, stating the relevant facts and conclusions, and the Scottish Ministers after taking such report into consideration shall give their decision and send it to the appellant and the Board.

    (10) Where, on allowing an appeal, the Scottish Ministers remit an application to the Board for reconsideration-

Consequential amendments
    
15. Schedule 1 to the 1995 Regulations is amended as follows-


MALCOLM CHISHOLM
A member of the Scottish Executive

St Andrew's House, Edinburgh
5th February 2003



SCHEDULE 1
Regulation 3


TERMS AND CONDITIONS FOR MEDICAL PRACTITIONERS INCLUDED IN SUPPLEMENTARY LIST


Interpretation
     1. In this Schedule, unless the context otherwise requires-

Incorporation of provisions of regulations, etc.
     2. Any provisions of the following affecting the rights and obligations of practitioners shall be deemed to form part of these terms of service:-

Performance of services
     3.  - (1) A practitioner shall be responsible for the treatment of such of the principal's patients as the principal requires and subject to and in accordance with any requirements or conditions imposed on the principal by the 1995 Regulations; and the practitioner shall in so assisting be expected to display the skill, knowledge and care appropriate to the nature of the assistance which the practitioner provides.

    (2) The skill, knowledge and care which a practitioner shall be expected to display in any circumstances required by this Schedule shall not be higher than that which a principal might reasonably be expected to exercise.

    (3) If requested to provide treatment, and available, a practitioner shall provide treatment immediately required, by reason of accident or other emergency, to a person who is not on the list of, and who has not been accepted as a temporary resident by or assigned to, any medical practitioner practising in the locality, or who is on the list of or has been accepted as a temporary resident by or assigned to, such a practitioner, but neither the said practitioner nor any deputy who may have been appointed is available.

    (4) Notwithstanding anything contained in this paragraph, a practitioner shall not be responsible under these terms of service for the treatment in hospital of a person admitted thereto for treatment by the staff of the hospital.

    (5) In its application to a practitioner who is a GP Registrar, this paragraph shall only require the performance of services under the supervision, or in accordance with the instructions, of the principal and the level of skill, knowledge and care expected shall only be that normally expected of a GP Registrar at the appropriate level of training.

Services to patients
     4.  - (1) Subject to paragraphs 3, 5 and 10, a practitioner shall provide to the principal's patients all necessary and appropriate medical services of the type usually provided by general medical practitioners.

    (2) The services which a practitioner is required by sub-paragraph (1) to provide shall include-

    (3) A practitioner shall not be required under sub-paragraph (1) or (2) to provide to any person-

    (4) In the case of emergency, the practitioner is required to render whatever services are, having regard to the circumstances, in the best interest of the patient.

    (5) In determining whether a particular service involves the application of such special skill and experience as aforesaid, regard is to be had to the question whether services of the kind are or are not usually undertaken by general medical practitioners practising in the area in which the question arose.

Treatment of patients
     5.  - (1) If the condition of a patient is such that the patient requires treatment which is not within the scope of the practitioner's obligations under these terms of service, but such treatment is to the knowledge of the practitioner available under the National Health Service, the practitioner shall inform the patient of the fact and if the patient so wishes, shall take all necessary steps to enable the patient to receive such treatment. The practitioner shall also give patients such advice or assistance as the practitioner considers appropriate to enable them to take advantage of other medical services available under the National Health Service.

    (2) Subject to the following provisions of this paragraph, a practitioner shall render the services referred to in paragraph 4 during the hours for which the principal is normally available (in this paragraph referred to as "normal hours") in accordance with paragraph 24 of Schedule 1 to the 1995 Regulations-

    (3) Outside normal hours the practitioner shall consider, in the light of the patient's medical condition, whether a consultation is needed, and if so, when and where it should take place having regard to the requirements imposed on the principal under paragraph 13 of Schedule 1 to the 1995 Regulations.

    (4) A practitioner shall issue to a patient or the patient's personal representatives free of charge any certificate of a description prescribed in the first column of Schedule 9 to the 1995 Regulations which is reasonably required under or for the purposes of the enactments specified in the second column of the said Schedule opposite and in relation to the description of the certificate in the first column.

    (5) The provisions of sub-paragraphs (2) and (3) above shall not apply in the case of a patient who attends when an appointment system is in operation and who has not previously made, and is not given, an appointment. In such a case the practitioner may decline to attend the patient during that surgery period, if the patient's health would not thereby be jeopardised and the patient is offered an appointment to attend within a reasonable time having regard to all circumstances. The practitioner shall take all reasonable steps to ensure that a consultation is not so deferred except in accordance with his instructions.

Prescribing and dispensing
     6.  - (1) Subject to sub-paragraph (2), a practitioner shall supply any drugs, not being a scheduled drug, or appliances for the immediate treatment of a patient if such treatment is necessary before a supply can be obtained otherwise, and may supply any other drug, not being a scheduled drug, which the practitioner administers in person, or an appliance listed in the Drug Tariff or a pessary which is an appliance.

    (2) A practitioner shall supply a restricted availability appliance only if it is for a patient in a category of person specified in the Drug Tariff.

    (3) Where the principal is required by the Board to supply drugs and appliances under regulation 34 of the 1995 Regulations to a patient, in the course of treating that patient under these terms of service a practitioner-

    (4) A practitioner shall comply with any arrangements made by the Scottish Ministers, or made by the Board after consultation with the Area Medical Committee and the Area Pharmaceutical Committee and approved by the Scottish Ministers, under which the principal may obtain and have available any drugs or appliances which are required or entitled to be supplied in terms of this paragraph.

    (5) A drug supplied by a practitioner unless administered in person shall be supplied in a suitable container.

     7.  - (1) Paragraph 9(2) does not apply to drugs, medicines or appliances ordered in a prescription form by a nurse prescriber.

    (2) Where a patient presents an order on a prescription form for listed drugs or medicines, or listed appliances, signed by a nurse prescriber, to a practitioner whose principal is required under regulation 34 of the 1995 Regulations to provide drugs or appliances to that patient, the practitioner may provide to the patient such of the drugs, medicines or appliances so ordered as are supplied in the normal course of practice.

    (3) A drug supplied under this paragraph shall be provided in a suitable container.

     8.  - (1) Before supplying the drugs or appliances recorded on a prescription form in accordance with paragraph 6(3)(a) or providing the listed drugs or medicines or listed appliances ordered on a prescription form signed by a nurse prescriber in accordance with paragraph 7(2) a practitioner whose principal is required by the Board under regulation 34 of the 1995 Regulations to provide drugs or appliances to a patient shall request any person who makes a declaration on the prescription form claiming either charge exemption under regulation 7 of the 2001 Regulations or charge remission under the National Health Service (Travelling Expenses and Remission of Charges) (Scotland) Regulations 1988[9] to provide evidence of the patient's entitlement to such exception or remission.

    (2) Sub-paragraph (1) shall not apply in respect of claims for exemption under regulation 7(1)(a) to (g) of the 2001 Regulations where the dispensing practitioner has information in his possession at the time of supplying the item which confirms that the patient is entitled to the exemption claimed.

    (3) Where the person presenting the prescription form does not show valid evidence of entitlement and the dispensing practitioner, in respect of a claim for exemption made under regulation 7(1)(a) to (g) of the 2001 Regulations does not have evidence to confirm that the patient is entitled to make that claim, the dispensing practitioner shall mark the patient's prescription form accordingly before supplying the prescribed item.

     9.  - (1) Subject to paragraphs 6 and 10 a practitioner shall order any drugs or appliances which are needed for the treatment of any patient to whom treatment is provided under these terms of service by issuing for that patient a prescription form, and such a form shall not be used in any other circumstances.

    (2) A prescription form shall be signed by the practitioner and shall not be written in such a manner as to necessitate reference on the part of the person supplying the drugs or appliances to a previous order, and in the case of an appliance which requires to be of a size suitable for the individual patient shall include the necessary measurements. A separate prescription form shall be used for each patient.

    (3) In a case of urgency a practitioner may request a pharmacist to dispense a drug before a prescription form is issued, only if-

    (4) In the case of urgency a practitioner may request a pharmacist to dispense an appliance before a prescription form is issued only if-

     10.  - (1) In the course of treating a patient to whom treatment is provided under these terms of service, a practitioner shall not order on a prescription form a scheduled drug, but may with the consent of the patient otherwise prescribe such a drug or other substance for that patient in the course of that treatment.

    (2) In the course of treating such a patient, a practitioner shall not order on a prescription form a drug specified in Schedule 11 to the 1995 Regulations unless-

but with the consent of the patient may otherwise prescribe such a drug for that patient in the course of that treatment.

Acceptance of fees
     11.  - (1) A practitioner shall not demand or accept any fee, remuneration or charge, other than payments due to the practitioner's principal under the 1995 Regulations, or any charge payable in accordance with the National Health Service (Charges for Drugs and Appliances) (Scotland) Regulations 2001, in respect of any treatment rendered or any drug or appliance supplied, whether under these terms of service or not, to a patient except-

    (2) In this paragraph, the expression "treatment" includes the provision of medical services during and following pregnancy and labour in respect of conditions arising therefrom.



SCHEDULE 2
Regulation 8(1)


INFORMATION AND DECLARATIONS TO BE INCLUDED IN AN APPLICATION FOR INCLUSION IN A SUPPLEMENTARY LIST


     1. An application shall contain the following information:-

     2. An application shall contain the following declarations:-



EXPLANATORY NOTE

(This note is not part of the Regulations)


These Regulations make provision for the preparation and keeping, by Health Boards, of lists of medical practitioners approved to assist in the provision of general medical services. Under section 24B(3) of the National Health Service (Scotland) Act 1978 only practitioners whose names are included in such a list may assist in the provision of such services under arrangements made by Boards.

In particular the Regulations provide for-


Notes:

[1] 1978 c.29. Section 19 was amended by the Health Services Act 1980 (c.53) ("the 1980 Act"), section 7, the Health and Social Services and Social Security Adjudications Act 1983 (c.41) ("the 1983 Act"), Schedule 7, paragraph 2, the Medical Act 1983 (c.54) Schedule 5, paragraph 17(c) and the National Health Service and Community Care Act 1990 (c.19), section 37 and is to be read with the Health and Medicines Act 1988 (c.49) section 17; section 24B and 24C(2) was inserted by section 18(2) of the Community Care and Health (Scotland) Act 2002 (asp 5); section 105(7) was amended by the 1980 Act, Schedule 6, paragraph 5 and Schedule 7 and by the 1983 Act, Schedule 9 paragraph 24; section 108(1) defines "prescribed" and "regulations".back

[2] S.I. 1995/416; amended by S.I. 1995/3199, 1996/842, 1504, 1997/943, 1473, 1998/4, 660, 1600, 1667, 1999/749, 1057, and 1999/1620 and by S.S.I. 2000/28, 153 and 2003/11.back

[3] S.I. 1995/414.back

[4] Command Paper 2073 and O.J. No. L 1, 3.1.1994, p.3.back

[5] Command Paper 2183 and O.J. No. L 3, 1 1994, p.572.back

[6] 1983 c.54.back

[7] 1968 c.67.back

[8] S.S.I. 2001/430.back

[9] S.I. 1988/546; as amended by S.I. 1995/700, 1196/429, 2391 and 1997/1012 and S.S.I. 1999/63.back

[10] 1971 c.38.back

[11] S.I. 2001/3998.back

[12] Section 57 was substituted by the Health and Medicines Act 1988 (c.49), section 7(11) and amended by the National Health Service and Community Care Act 1990 (c.19) Schedule 9, part 19(10) and Schedule 10.back

[13] 1998 c.52.back

[14] Section 26 was amended by the Health and Social Security Act 1984 (c.48) Schedules 1 and 8 and by the Health and Medicines Act 1988 (c.49) section 13(4).back

[15] Section 26(1E) was inserted by the Health and Medicines Act 1988 (c.49) section 13(4).back

[16] S.I. 1998/5.back



ISBN 0 11061999 4


 
© Crown copyright 2003
Prepared 17 February 2003


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