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Whereas a draft of this Order in Council has been approved by resolution of each House of Parliament: Now, therefore, Her Majesty, in exercise of the powers conferred by paragraph 1(1) of the Schedule to the Northern Ireland Act 2000 (c.1) and of all other powers enabling Her in that behalf, is pleased, by and with the advice of Her Privy Council, to order, and it is hereby ordered, as follows:- Title and commencement 1. - (1) This Order may be cited as the Primary Medical Services (Northern Ireland) Order 2004. (2) This Article, and Articles 2, 5 and 11, shall come into operation on the expiration of 7 days from the day on which this Order is made. (3) The other provisions of this Order shall come into operation on such day or days as the Department may by order appoint. Interpretation 2. - (1) The Interpretation Act (Northern Ireland) 1954 (c. 33) shall apply to Article 1 and the following provisions of this Order as it applies to an Act of the Assembly. (2) In this Order -
Provision of primary medical services 3. For Article 56 of the 1972 Order (arrangements for general medical services) and the heading "General medical services" preceding that Article there shall be substituted - Primary medical services 56. - (1) Each Health and Social Services Board shall, to the extent that it considers necessary to meet all reasonable requirements, exercise its powers so as to provide primary medical services within its area, or secure their provision within its area. (2) A Health and Social Services Board may (in addition to any other power conferred on it) -
(b) make such arrangements for their provision (whether within or outside its area) as it thinks fit, and may in particular make contractual arrangements with any person.
(3) Each Health and Social Services Board shall publish information about such matters as may be prescribed in relation to the primary medical services provided under this Part.
General medical services contracts General medical services contracts: introductory 57. - (1) A Health and Social Services Board may enter into a contract under which primary medical services are provided in accordance with the following provisions of this Part. (2) A contract under this Article is called in this Order a "general medical services contract". (3) Subject to any provision made by or under this Part, a general medical services contract may make such provision as may be agreed between the Health and Social Services Board and the contractor or contractors in relation to -
(b) remuneration under the contract, and (c) any other matters.
(4) The services to be provided under a general medical services contract may include -
(b) services to be provided outside the area of the Health and Social Services Board.
(5) In this Part, "contractor", in relation to a general medical services contract, means any person entering into the contract with the Health and Social Services Board.
(b) two or more individuals practising in partnership where the conditions in paragraph (2) are satisfied; or (c) a company limited by shares where the conditions in paragraph (3) are satisfied.
(2) The conditions referred to in paragraph (1)(b) in relation to a partnership are that -
(b) any partner who is not a medical practitioner is either -
(ii) an Article 15B employee, a section 28C employee or a section 17C employee; (iii) a health care professional who is engaged in the provision of services under this Order; or (iv) an individual falling within Article 15C(1)(b)(iii).
(3) The conditions referred to in paragraph (1)(c) in relation to a company are that -
(b) any share which is not so owned is legally and beneficially owned by a person referred to in paragraph (2)(b)(i) to (iv).
(4) Regulations may make provision as to the effect, in relation to a general medical services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.
General medical services contracts: payments
(b) provide for payments to be made by reference to -
(ii) a determination made by any person in accordance with factors specified in the direction;
(c) provide for the making of payments in respect of individual practitioners;
(4) Before giving a direction under paragraph (1), the Department -
(b) may consult such other persons as it thinks appropriate.
(5) References in this Article to payments include fees, allowances, reimbursements, loans and repayments.
(b) the persons who perform services; (c) the persons to whom services are to be provided; (d) the variation of contract terms (other than terms required by or under this Part); (e) rights of entry and inspection (including inspection of clinical records and other documents); (f) the circumstances in which, and the manner in which, the contract may be terminated; (g) enforcement; (h) the adjudication of disputes.
(3) Regulations making provision under paragraph (2)(c) shall make provision as to the circumstances in which a contractor or contractors -
(b) may decline to accept a person as such a patient; or (c) may terminate his or their responsibility for a patient.
(4) Regulations under paragraph (2)(d) may -
(b) make provision suspending or terminating any duty under the contract to provide services of a prescribed description.
(5) Regulations making provision of the kind described in paragraph (4)(b) may prescribe services by reference to the manner or circumstances in which they are provided.
(b) for the Department, or a person appointed by it, to determine the terms on which the contract may be entered into.
(3) Regulations may make provision for a person or persons entering into a general medical services contract to be regarded as a health and social services body for any purposes of Article 8 of the Health and Personal Social Services (Northern Ireland) Order 1991, in circumstances where he or they so elect.
(b) there is a change in the membership of the partnership.
(5) Where -
(b) a direction as to payments is made under that paragraph in relation to the contract,
the direction is to be enforceable in a county court (if the court so orders) as if it were a judgment or order of that court.".
General medical services: transitional
Primary medical services or personal dental services
(c) sub-paragraph (a) of paragraph (3), in paragraph (4) the words "personal medical services or", and in paragraph (6) the definition of "personal medical services" shall be omitted.
(3) In Article 15C (persons with whom agreements under Article 15B may be made) for sub-paragraph (b) of paragraph (1) there shall be substituted -
(ii) a health care professional who satisfies the prescribed conditions; (iii) an individual who is providing services -
(B) in accordance with Article 15B arrangements, section 28C arrangements or Article 17C arrangements; or (C) under section 28Q of the National Health Service Act 1977 or section 19 of the National Health Service (Scotland) Act 1978;
or has so provided them within such period as may be prescribed;".
(4) After paragraph (1) of that Article there shall be inserted -
(5) In paragraph (2) of that Article -
(6) In paragraph (2) of that Article, in the definition of "HSS employee" -
(b) in paragraph (a), after the word "trust" there shall be inserted "in Northern Ireland, or an NHS trust or NHS foundation trust in England and Wales"; (c) for paragraph (b) there shall be substituted -
(bb) a person who is providing services under a general medical services contract; (bc) an individual who is providing services as specified in paragraph (1)(bc)(iii);".
(7) In Article 15D (regulations concerning Article 15B arrangements) -
(b) in paragraph (2)(b), the words "medical practitioners performing personal medical services, and" shall be omitted.
(8) In paragraph (3) of that Article -
(b) sub-paragraphs (f) and (g) shall be omitted; and
(9) After paragraph (3) of that Article there shall be inserted -
(3B) A direction under paragraph (3A) may make provision having effect from a date before the date of the direction, provided that, having regard to the direction as a whole, the provision is not detrimental to the persons to whose remuneration it relates. (3C) The regulations may also include provision requiring a Health and Social Services Board, in prescribed circumstances and subject to prescribed conditions, to enter into a general medical services contract on prescribed terms with any person providing services under Article 15B arrangements who so requests. (3D) The regulations may also include provision for the resolution of disputes as to the terms of any proposed Article 15B arrangements, and in particular may make provision -
(b) for the Department, or a person appointed by it, to determine the terms on which the arrangements may be entered into.
(3E) The regulations shall provide for the circumstances in which a person providing primary medical services under Article 15B arrangements -
(b) may decline to accept a person as such a patient; (c) may terminate his responsibility for a patient.
(3F) The regulations shall make provision as to the right of patients to choose the persons from whom they are to receive services under Article 15B arrangements.".
(10) Paragraphs (5) and (7) of that Article shall be omitted and in paragraph (6) of that Article for "personal medical services" there shall be substituted "primary medical services". Persons performing primary medical services 57G. - (1) Regulations may provide that a health care professional of a prescribed description may not perform any primary medical service for which a Health and Social Services Board is responsible unless that professional is included in a list maintained under the regulations by the Health and Social Services Board. (2) For the purposes of this Article -
(b) a Health and Social Services Board is responsible for a primary medical service if it provides the service, or secures provision of the service, under or by virtue of Article 56.
(3) Regulations under paragraph (1) may make provision in relation to such lists and in particular as to -
(b) eligibility for inclusion in a list; (c) applications for inclusion (including provision as to the Health and Social Services Board to which an application must be made, and for the procedure for applications and the documents to be supplied on application); (d) the grounds on which an application for inclusion may or must be granted or refused; (e) requirements with which a person included in a list must comply (including the declaration of financial interests and gifts and other benefits); (f) suspension or removal from a list or references to the Tribunal (including the grounds for and consequences of suspension or removal, or reference); (g) circumstances in which a person included in a list may not withdraw from it; (h) payments to be made in respect of a person suspended from the list (including provision for the amount of, or the method of calculating, the payment to be determined by the Department, or a person appointed by it); (i) the criteria to be applied in making decisions under the regulations; (j) appeals against decisions made by a Health and Social Services Board under the regulations; (k) disclosure of information about applicants for inclusion, refusals of applications, or suspensions, removals or references.
(4) Regulations making provision as to the matters referred to in paragraph (3)(k) may in particular authorise the disclosure of information -
(b) by the Department to a Health and Social Services Board.".
(3) In paragraph 1 of Schedule 11 (disqualification of persons providing services) -
(b) after that sub-paragraph there shall be inserted -
Assistance and support
57H. - (1) A Health and Social Services Board may provide assistance or support to -
(b) any person providing, or proposing to provide, such services in accordance with Article 15B arrangements.
(2) Assistance or support provided by a Health and Social Services Board under paragraph (1) shall be provided on such terms, including terms as to payment, as the Board thinks fit.
Minor and consequential amendments 10. Schedule 1 (which contains minor and consequential amendments) shall have effect. Supplementary provision 11. - (1) The Department may by order make such transitional or transitory provisions and savings as it considers appropriate in connection with the coming into operation of any provision of this Order. (2) Nothing in Article 5 restricts the power under paragraph (1) to make other transitional provisions. (3) The Department may by order make such supplementary, incidental, or consequential provision as it considers appropriate for the purposes of, in consequence of or for giving full effect to any provision of this Order. (4) An order under paragraph (1) or (3) may modify any statutory provision. (5) In paragraph (4) -
(6) An order made under this Article shall be subject to negative resolution. 1. The Order of 1972 shall have effect subject to the following amendments. 2. In Article 2 (interpretation), in paragraph (2) -
3.
- (1) Article 5 (provision of accommodation and medical services, etc.) shall be amended as follows.
4.
- (1) In Article 6 (provision of general health services), the existing provision shall be numbered as paragraph (1) of that Article.
5.
In Article 11 (vaccination and immunisation), in paragraph (2) for "general medical services" and "personal medical services" substitute "primary medical services".
(b) paragraph (5)(a) and (b), and (c) in paragraph (7), "medical practitioner or".
8.
- (1) Article 55A (functions of local representative committees) shall be amended as follows.
(b) omit sub-paragraphs (a) and (b).
(5) In paragraph (6), omit "general medical services".
55B. - (1) A Health and Social Services Board may recognise a committee formed for its area, or for its area and that of one or more other Health and Social Services Boards, which it is satisfied is representative of -
(b) the persons to whom paragraph (3) applies.
(2) This paragraph applies to -
(b) every medical practitioner who is providing general ophthalmic services in that area.
(3) This paragraph applies to every other medical practitioner -
(ii) in accordance with Article 15B arrangements; or (iii) under a general medical services contract; and
(b) who has notified the Health and Social Services Board that he wishes to be represented by the committee (and has not notified it that he wishes to cease to be so represented).
(4) A committee recognised under this Article shall be called the Local Medical Committee for the area for which it is formed.
(b) the amount of its administrative expenses for that year attributable to persons of whom it is representative under paragraph (1)(b).
(9) A Health and Social Services Board may -
(b) deduct the amount of such sums from the remuneration of persons of whom it is representative under paragraph (1)(a) under the general medical services contracts, or arrangements under Article 62, entered into by them with the Board.
(10) A committee recognised under this Article shall apportion the amount determined by it under paragraph (8)(b) among the persons of whom it is representative under paragraph (1)(b); and each such person shall pay in accordance with the committee's directions the amount so apportioned to him.
10.
In the following provisions -
(b) paragraph (1)(a) of Article 64 (persons authorised to provide pharmaceutical services); (c) paragraph 1(b)(i) of Schedule 6 (removal to suitable premises of persons in need of care and attention); (d) paragraph 1 of Schedule 9 (provision for making loans to general medical practitioners);
for "general medical services" substitute "primary medical services".
(b) in sub-paragraph (b), at the end insert "(prior to the coming into operation of Article 3 of the Primary Medical Services (Northern Ireland) Order 2004)"; (c) after that sub-paragraph insert
(c) provided or performed primary medical services in accordance with Article 15B arrangements, arrangements under Article 56B(2)(b) or under a general medical services contract -
(ii) if regulations so provide, in all circumstances;".
(3) In paragraph 4, for "general medical services or personal medical services" substitute "or performed services as specified in paragraph 1(1)". 13. In Article 10 of the Health and Medicines (Northern Ireland) Order 1988 (NI 24) (arrangements for provision of general medical services, etc.), in paragraph (1) omit "56". 14. - (1) The Health and Personal Social Services (Northern Ireland) Order 1991 (NI 1) shall be amended as follows. (2) In Article 21 (indicative amounts for doctors' practices) in paragraph (3), for sub-paragraphs (a) and (b) substitute -
(b) two or more individuals practising in partnership who together have entered into such a contract;".
(3) After paragraph (8) of that Article insert -
(4) In Schedule 1 (health and social services councils), in paragraph (2)(g) for "and HSS trusts" substitute "HSS trusts and persons providing primary medical services under Part II or Part VI of the principal Order". 15. - (1) The Access to Health Records (Northern Ireland) Order 1993 (NI 4) shall be amended as follows. (2) In Article 2 (interpretation), in paragraph (2) -
(3) In Article 3 (meaning of "health record", etc.) in paragraph (2), for sub-paragraph (a) substitute -
(aa) in the case of a record made by a health professional performing such services in accordance with arrangements under Article 15B of the Health and Personal Social Services (Northern Ireland) Order 1972 with a Health and Social Services Board, the person or body which made the arrangements with the Board (or, in a case where more than one person so made the arrangements, any such person);".
(4) In that paragraph, in sub-paragraph (b), after "by a health service body" insert "(and not falling within sub-paragraph (aa))"
(b) in paragraph (3), omit the words from "(other" to "Article 3(2)(a))".
16.
- (1) Article 144 of the Trade Union and Labour Relations (Northern Ireland) Order 1995 (NI 12) (health service practitioners) shall be amended as follows.
(b) under a contract under Article 57 of that Order entered into by him with a Health and Social Services Board,
and "employer" in relation to such an individual, regarded in that capacity, means that Board.".
17. - (1) Article 67K of the Employment Rights (Northern Ireland) Order 1996 (NI 16) (extension of meaning of "worker" etc. for Part VA) shall be amended as follows. (2) In paragraph (1), after sub-paragraph (b) insert -
(3) In paragraph (2), after sub-paragraph (a) insert -
18.
In Part III of Schedule 1 to the Freedom of Information Act 2000 (c. 36) (public authorities in the National Health Service), in paragraph 51 for "general medical services" substitute "primary medical services".
(This note is not part of the Order) This Order amends the Health and Personal Social Services (Northern Ireland) Order 1972 to facilitate implementation of a new general medical services contract for providers of primary medical services in Northern Ireland. ISBN 0 11049134 3
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