Standard GMS Contract Variation Notice March 2006 STANDARD GENERAL MEDICAL SERVICES CONTRACT VARIATION NOTICE MARCH 2006

Transcription

1 STANDARD GENERAL MEDICAL SERVICES CONTRACT VARIATION NOTICE MARCH 2006 The text of the Standard General Medical Services Variation Notice March 2006 has been prepared for use in Wales by the National Assembly for Wales. It is adapted from text prepared by the Department of Health s Solicitors and has been approved by solicitors acting for the GPC. It is prepared on the basis that the numbering adopted in the signed contract follows that used in the Standard General Medical Services Contract dated 1 April 2004.

2 Dear Sir/Madam Notice of Variation to your General Medical Services Contract dated [ ] We give you notice under paragraph 102(2) of Schedule 6 to the National Health Service (General Medical Services Contracts) Regulations 2004 (S.I. 2004/478 (W.48)) that the terms of your general medical services contract dated [ ] are varied as set out below with effect from- Except for the variations within paragraph 2 of this notice, 1 March 2006, the variations within paragraph 2 of this notice, 1 April These variations are made to comply with the terms of the National Health Service (Primary Medical Services) (Miscellaneous Amendments) (Wales) Regulations 2006 (S.I. 2006/358 (W.46)). We request you to acknowledge receipt of this notice by signing and returning the enclosed duplicate of it. Dated: Signed: on behalf of [ ] Local Health Board Print name:

3 WORDING OF VARIATIONS PART 1 DEFINITIONS AND INTERPRETATION 1. The following variations are made to clause 1: 1.1 The definition of bank holiday is replaced as follows: bank holiday means any day that is specified or proclaimed as a bank holiday in England and Wales pursuant to section 1 of the Banking and Financial Dealings Act 1971;. 1.2 After the definition of cervical screening services, the following definition is inserted: the Charges Regulations means the National Health Service (Charges for Drugs and Appliances) (Wales) Regulations ;. 1.3 After the definition of closed, the following definition is inserted: complete course means the course of treatment appropriate to the patient s condition being the same amount that would have been prescribed if the patient had been seen during core hours;. 1.4 The definition of general medical practitioner is replaced with the following: general medical practitioner means, unless the context otherwise requires- 1 S.I.2001/1358 (W.86).

4 (a) from the coming into force of article 10 of the 2003 Order, a medical practitioner whose name is included in the General Practitioner Register; and (b) until the coming into force of that article, a medical practitioner who is eitheri. until the coming into force of paragraph 22 of Schedule 8 to the 2003 Order, suitably experienced within the meaning of section 31(2) of the Act, section 21 of the National Health Service (Scotland) Act 1978 or Article 8(2) of the Health and Personal Social Services (Northern Ireland) Order 1978 or a person who has an acquired right to practise as a general medical practitioner pursuant to regulation 5(1)(d) of the Vocational Training for General Medical Practice (European Requirements) Regulations , or ii. upon the coming into force of paragraph 22 of Schedule 8 to the 2003 Order, an eligible general practitioner pursuant to that paragraph;. 1.5 The definition of GP Registrar is replaced with the following: GP Registrar means a medical practitioner who is being trained in general practice by- (a) until the coming into force for all purposes of article 4(5)(d) of the 2003 Order, a general medical practitioner who- 1 S.I.1994/3130

5 i. has been approved for that purpose by the Joint Committee on Postgraduate Training for General Practice under regulation 7 of the National Health Service (Vocational Training for General Medical Practice) Regulations , and ii. performs primary medical services, and (b) from the coming into force for all purposes of that article, a general medical practitioner who is approved under that article for the purpose of providing training under article 5(1)(c)(i) of the 2003 Order, whether as part of training leading to the award of a CCT or otherwise;. 1.6 The definition of GP Trainer is omitted. 1.7 After the definition of health care professional, the following definition is inserted: the health service means the health service established in pursuance of section 1 of the National Health Service Act 1946 and continued under section 1(1) of the Act;. 1.8 In the definition of immediate family member, after spouse insert or civil partner. 1.9 The definition of NCAA is omitted After the definition of national disqualification, the following definition is inserted: 1 S.I.1997/2817

6 necessary drugs, medicines and appliances, means those drugs, medicines and appliances which the patient requires and for which, in the reasonable opinion of the Contractor, and the light of the patient s medical condition, it would not be reasonable in all the circumstances for the patient to wait until such time as he could obtain them during core hours; After the definition of normal hours, the following definition is inserted: NPSA means the National Patient Safety Agency established as a Special Health Authority by the National Patient Safety Agency (Establishment and Constitution) Order 2001; After the definition of out of hours opt out notice, the following definition is inserted: out of hours performer means a prescriber, a person acting in accordance with a Patient Group Direction or any other health care professional employed or engaged by the Contractor who can lawfully supply a drug, medicine or appliance, who is performing out of hours services under the Contract; In the definition of out of hours services the words by the Contractor to its registered patients are inserted after the words if provided in paragraph (a) After the definition of patient, the following definition is inserted: Patient Group Direction has the same meaning as in the Prescription Only Medicines (Human Use) Order 1997; After the definition of permanent opt out notice, the following definition is inserted:

7 personal number means a telephone number which starts with the number 070 followed by a further eight digits; The definition of supplementary prescriber is replaced as follows: supplementary prescriber means a person- (a) who is either engaged or employed by the Contractor or is a party to the contract, (b) whose name is registered in- (i) the Nursing and Midwifery Register; (ii) the Register of Pharmaceutical Chemists maintained in pursuance of section 2(1) of the Pharmacy Act 1954; (iii) the register maintained in pursuance of Articles 6 and 9 of the Pharmacy (Northern Ireland) Order 1976; or (iv) the part of the Register maintained by the Health Professions Council in pursuance of article 5 of the Health Professions Order relating to- (aa) chiropodists and podiatrists; (bb) physiotherapists; (cc) radiographs: diagnostic or therapeutic; or (dd) the register of optometrists maintained by the general optical council in pursuance of section 7 of the Opticians Act , and (c) against whose name is recorded in the relevant register an annotation or entry signifying that he is qualified to order 1 S.I.2002/254 (as amended by S.I.2004/2033).

8 drugs, medicines and appliances as a supplementary prescriber; After the definition of supplementary prescriber, the following definition is inserted: supply form means a form supplied by an LHB and completed by or on behalf of the Contractor for the purpose of recording the provision of drugs, medicines or appliances to a patient during the out of hours period;. PARTS 2 to 5 No variations. PART 6 PROVISION OF SERVICES 2. After clause 29, the following new clause is inserted: Telephone Services 29A. The Contractor shall not be a party to any contract or other arrangement under which the number for telephone services to be used by- 29A.1 patients to contact the practice for any purpose related to the Contract; or 29A.2 any other person to contact the practice in relation to services provided as part of the health service, starts with the digits 087, 090, or 091 or consists of a personal number, unless the service is provided free to the caller c.44

9 3. In clause 39 the sentence This clause does not apply in relation to out of hours services provided by the Contractor on or after 1 March is added at the end of the clause. PART 7 No variations PART 8 ADDITIONAL SERVICES 4. Clause 69.1 is replaced as follows: 69.1 the provision of any necessary information and advice to assist relevant patients in making an informed decision as to participation in the Cervical Screening Wales Programme undertaken by Velindre NHS Trust on behalf of the National Assembly for Wales; 69.1A. for the purpose of clause 69.1 relevant patients means female patients on the Contractor s patient list who have been identified by Velindre NHS Trust as suitable candidates for a cervical screening test;. 5. In clause 72.1 the words influenza vaccination are replaced by influenza and pneumococcal vaccinations. PART 9 OUT OF HOURS SERVICES 6. Clause 85 is varied as follows: (a) after must the words have regard to are inserted; and (b) meet is omitted.

10 7. After clause 85 the following new clauses are inserted: Supply of medicines etc. by contractors providing out of hours services 1 85A. If the Contract includes the supply of necessary drugs, medicines and appliances to patients at the time that the Contractor is providing them with out of hours services, the Contractor shall comply with the requirements in clauses 85B to 85E. 85B. The Contractor shall ensure that an out of hours performer- 85B.1. only supplies necessary drugs, medicines and appliances; 85B.2. supplies the complete course of the necessary medicine or drug required to treat the patient; and 85B.3. does not supply- 85B.3.1. drugs, medicines or appliances which he could not lawfully supply, 85B.3.2. appliances which are not listed in Part IX of the Drug Tariff, 85B.3.3. restricted availability appliances, except where the patient is a person, or it is for a purpose, specified in the Drug Tariff, or 85B.3.4. a drug, medicine or other substance listed in Schedule 1 to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc) (Wales) Regulations , or a drug, medicine or other 1 The variation in paragraph 5 should only be included if the Contractor is providing out of hours services. 2 S.I.204/1022 (W.119)

11 substance listed in Schedule 2 to those Regulations other than in the circumstances specified in that Schedule. 85C. The out of hours performer shall record on a separate supply form for each patient any drugs, medicines or appliances supplied to the patient provided that a single supply form may be completed where the Contractor supplies necessary drugs, medicines or appliances to two or more persons in a school or other institution in which at least 20 persons normally reside, when the out of hours performer may write on the supply form the name of the school or institution rather than the name of the individual patient. 85D. The out of hours performer shall ask any person who makes a declaration that the patient does not have to pay the charges specified in regulation 4(1) of the Charges Regulations by virtue of either- 85D.1. entitlement to exemption under regulation 8(1) of the Charges Regulations; or 85D.2. entitlement to remission of charges under regulation 3 of the National Health Service (Travelling Expenses and Remission of Charges) Regulations , to produce satisfactory evidence of entitlement, unless the declaration is in respect of entitlement to exemption by virtue of regulation 8(1) of the Charges Regulations, and at the time of the declaration the out of hours performer already has such evidence available to him. 85E. If no satisfactory evidence is produced to him as required by clause 85D (and, where it is relevant, none is readily available to him as 1 S.I.1988/551

12 mentioned in that clause), the out of hours performer shall endorse the supply form to that effect. 85F. Subject to clause 85G, nothing in clauses 85A to 85E shall prevent an out of hours performer supplying a Scheduled drug or a restricted availability appliance in the course of treating a patient under a private arrangement. 85G. The provisions of Part 18 apply in respect of the supply of necessary drugs, medicines and appliances under clauses 85A to 85E as they apply in respect of prescriptions for drugs, medicines and appliances.. PARTS 10 to 11 No variations. PART 12 PATIENTS 8. In clause 247 the words Clause 248 to 252 are replaced by Clause 248 to Clause is replaced as follows: that list shall re-open before the expiry of the period referred to in clause if the number of the Contractor s registered patients falls to the number specified by the assessment panel in accordance with paragraph 31(8)(b) of Schedule 6 to the Regulations as the number of registered patients which, if that number were reached, would trigger the re-opening of the Contractor s list of patients; or

13 the LHB and the Contractor agree that the list of patients should re-open After clause 252 there are inserted two new clauses in the following terms: 252A. If the Contractor s list of patients has re-opened pursuant to clause , it shall nevertheless close again if, during the period specified by the assessment panel as the period for which the list should remain closed, the number of the Contractor s registered patients rises to the number specified by the assessment panel in accordance with paragraph 31(8)(b) of Schedule 6 to the Regulations as the number of registered patients which, if that number were reached, would trigger the re-closure of the Contractor s list of patients. 252B. Except in cases where the Contractor s list of patients is already open pursuant to clause , the LHB shall notify the Contractor in writing between seven and fourteen days before the expiry of the closure period referred to in clause 252.1, confirming the date on which the contractors list of patients will re-open In clause 298, clause is replaced by clause In clause 321.1, paragraph (2) is replaced by paragraph (1)(c). PART 13 PRESCRIBING AND DISPENSING 13. The wording of clause is omitted, and the clause left as an unused number. 14. The wording of clause is omitted, and the clause left as an unused number.

14 15. The wording of clause is omitted, and the clause left as an unused number. 16. The wording of clause is omitted, and the clause left as an unused number. 17. The wording of clause 299 is omitted, and the clause left as an unused number. 18. Clause 329 is replaced as follows: 329 If the Contractor is providing dispensing services, it shall comply with paragraph 36 of Schedule 2 to the Pharmaceutical Regulations, modified as follows for paragraph 34(1), substitute paragraph 49(4) of Schedule 6 to the Regulations ; for paragraph 35(a), substitute paragraph 49(2)(a) of Schedule 6 to the Regulations ; for a doctor who is authorised or required by the Local Health Board under regulation 20 to provide drugs and appliances to a patient, substitute a Contractor providing dispensing services to a patient ; for doctor in both places where is appears, substitute medical practitioner.. PART 14 PERSONS WHO PERFORM SERVICES 19. Clause is replaced as follows:

15 336.3 a GP Registrar who has applied to a LHB to have his or her name included in its medical performers list until the first of the following events arises the LHB notifies him of its decision on that application; or the end of a period of two months, starting with the date on which the his vocational training scheme began, and in this sub-clause, vocational training scheme shall have the meaning given in regulation 21(1) of the National Health Service (Performers Lists) (Wales) Regulations In clause 351, providing is replaced by performing. 21. Clause 354 is replaced as follows: 354. The Contractor shall only employ a GP Registrar subject to the conditions in clause In clause 363.2, NCAA is replaced by NPSA. 23. Clause 387 is replaced as follows: 387 A notice served under clause 386 shall take effect on the date on which it is received by the Contractor.. PART 15 RECORDS, INFORMATION, NOTIFICATION AND RIGHTS OF ENTRY 24. Clause is varied as follows: 1 S.I.2004/1020 (W.117)

16 (a) Good Practice Guidelines for General Practice Electronic Patient Records published on 26 th September 2003 is replaced by Good Practice Guidelines for General Practice Electronic Patient Records (version 3.1) published on 29 th July 2005 ; and (b) is replaced with arycare/primarycarecomputing. 25. The wording of clauses 426 and 427 is omitted and the clauses left as unused numbers. 26. After clause 431 there is inserted a new clause in the following terms: 431A. The Contractor shall produce the information requested, or, as the case may be, allow access to it: 431A.1 by such date as has been agreed as reasonable between the Contractor and the LHB; or 431A.2 in the absence of such agreement, within 28 days of the request being made After clause 437 there are inserted two new clauses in the following terms: 437A. Subject to article 50 of the General Medical Services Transitional and Consequential Provisions (Wales) (No.2) Order , one such return may be requested by the LHB at any time during each financial year in relation to such period (not including any period covered by a previous 1 S.I.2004/1016 (W.113)

17 annual return) as may be specified in the request: in this clause, financial year means the twelve months ending with 31 st March. 437B. The Contractor shall submit the completed return to the LHB- 437B.1 by such date as has been agreed as reasonable between the Contractor and the LHB; or 437B.2 in the absence of such agreement, within 28 days of the request being made After clause the following new clause is inserted 1 : 444.1A a new director or secretary is appointed;. 29. After clause 445 the following new clause is inserted: 445A. A notice under clause 444.1A shall confirm that the new director or, as the case may be, secretary meets the conditions imposed on directors and secretaries by virtue of regulation 5 of the Regulations In clause 456 the words sections 66 and 73 are replaced by sections 66, 67, 72 and 73. PARTS 16 to 19 No variations. PART 20 INSURANCE

18 31. In clause the words an employee of its in connection with clinical services which that employee are replaced by a person employed or engaged by it in connection with clinical services which that person. PART 21 GIFTS 32. In clause after spouse the words or civil partner are inserted. PART 22 No variations. PART 23 COMPLAINTS 33. In clause 502 the words save that this clause shall not apply in relation to out of hours services provided by the Contractor on or after 1 March are added after the word Contract. PART 24 DISPUTE RESOLUTION No variations. PART 25 VARIATION AND TERMINATION OF THE CONTRACT 34. Clause 526 is replaced as follows 2 : 1 The variations in paragraph 28 and 29 should only be included if the Contractor is a company limited by shares. 2 The variations in paragraphs 34 and 35 should only be included if the Contractor is a partnership.

19 526. If the partnership is terminated or dissolved because, in a partnership consisting of two individuals practising in partnership, one of the partners has died, the remaining individual shall notify the LHB in writing as soon as is reasonably practicable of the death of his partner and clause 526A or 526B shall apply. 526A. If the remaining individual is a general medical practitioner, the Contract shall continue with that individual. 526B. If clause 526A does not apply, the LHB may, if it thinks fit, serve notice in writing on the remaining individual confirming that the LHB will allow the Contract to continue with that individual, for a period specified by the LHB of up to six months (the interim period ) provided that the remaining individual consents to the LHB employing or supplying a general medical practitioner to him for the interim period to assist in the provision of clinical services under the contract. 526C. Before deciding whether to serve a notice pursuant to clause 526B, the LHB shall, whenever it is reasonably practicable to do so, consult with the Local Medical Committee (if any) for its area. 526D. If, during the interim period, the Contractor withdraws its consent to the LHB employing or supplying a general medical practitioner, the LHB shall serve notice in writing on the Contractor terminating the contract forthwith. 526E. If, at the end of the interim period, the Contractor has not entered into partnership with a general medical practitioner who is not a limited partner, the LHB shall serve notice on the Contractor terminating the contract forthwith After clause 528 the following new clause is inserted:

20 528A. In clauses 526A, B, D and E, general medical practitioner has the same meaning as in regulation 4(1) of the Regulations After clause 529 the following new clause is inserted 1 : Termination on the death of an individual medical practitioner 529A. Where the Contractor dies, the Contract shall terminate at the end of the period of seven days after the date of his death unless, before the end of that period- 529A.1. the LHB has agreed in writing with the Contractor s personal representatives that the Contract should continue for a further period, not exceeding 28 days after the end of the period of seven days; and 529A.2. the Contractor s personal representatives have consented in writing to the LHB employing or supplying one or more general medical practitioners to assist in the provision of clinical services under the Contract throughout the period for which it continues. 529B. In clause 529B.2, general medical practitioner has the same meaning as in regulation 4(1) of the Regulations. 529C. Clause 529A does not affect any other rights to terminate the Contract which the LHB may have under clauses 544 to In clause 538 the words Subject to clauses 538A and 543A are inserted at the beginning of the clause.

21 38. After clause 538 the following new clause is inserted: 538A. Where the failure of an individual medical practitioner to continue to satisfy the condition specified in regulation 4(1) of the Regulations is the result of a suspension specified in clause 540B, clause 538 shall not apply unless- 538A.1. the Contractor is unable to satisfy the LHB that it has in place adequate arrangements for the provision of clinical services under the Contract for so long as the suspension continues; or 538A.2. the LHB is satisfied that the circumstances of the suspension are such that if the Contract is not terminated forthwith- 538A.2.1 the safety of the Contractor s patients is at serious risk; or 538A.2.2 the LHB is at risk of material financial loss In clause 539 the words Subject to clause 543A and except in a case to which clause 526 applies, are inserted at the beginning of the clause. 40. In clause the words of up to six months are replaced by in accordance with clause 540A. 41. After clause the following new clause is inserted: 540A. The period specified by the LHB under clause shall not exceed- 540A.1. six months; or 1 The variation in paragraph 36 should only be included in the variation notice if the Contractor is an

22 540A.2. in a case where the failure of the Contractor to continue to satisfy the condition in regulation 4(2)(a) or, as the case may be, 4(3)(a) of the Regulations, is the result of a suspension referred to in clause 540B, the period for which that suspension continues. 540B. The suspensions referred to in clauses 538A and 540A.2 are suspension- 540B.1. by a Fitness to Practise Panel under- 540B.1.1. section 35D of the Medical Act 1983 in a health case, other than an indefinite suspension under section 35D(6) of that Act; or 540B.1.2. section 38(1) of that Act; or 540B.2. by a Fitness to Practise Panel or an Interim Orders Panel under section 41A of that Act. 540C. In clause 540B.1.1, health case has the meaning given in section 35E(4) of the Medical Act After clause 543 there is inserted the following new clauses: 543A. Clauses 538 to 540 shall not apply to the Contractor where regulation 14 of the National Health Service (Primary Medical Services) (Miscellaneous Amendments) (Wales) Regulations 2006 applies. individual medical practitioner.

23 543B. In clauses 540 and 542, general medical practitioner has the same meaning as in regulation 4(1) of the Regulations Clause 544 is replaced as follows: 544. The LHB may serve notice in writing on the Contractor terminating the Contract forthwith, or from such date as may be specified in the notice if, after this Contract was entered into, it has come to the attention of the LHB that written information provided to the LHB by the Contractor before the Contract was entered into; or pursuant to clauses 445, 445A or 447, in relation to the conditions set out in regulations 4 and 5 of the Regulations (and compliance with those conditions) was, when given, untrue or inaccurate in a material respect In clause 545 at the end add the words or, if later, on or after the date on which a notice in respect of his compliance with the conditions in regulation 5 of the Regulations was given under clauses 445, 445A or In clause 567, clause 565 is replaced by clause In clause 573, 555 or 571 is replaced by 555, 557 or 561. PART 26 No variations.

24 SCHEDULES No variations. I/We [ ] acknowledge receipt of the notice of variation dated [ ] of which the above is a duplicate. I/We acknowledge that this notice will take effect from [ ] and from [ ]. Signed: [on behalf of ]: Print name: Date:

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