New Clause 27: Health and Social Care (Community Health and Standards) Bill
New Clause 27— General medical services contracts
'(1) In the 1977 Act, after section 28P (as inserted by section 163 above) insert—
"General medical services contracts
28Q General medical services contracts: introductory
(1) A Primary Care Trust or Local Health 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 section is called in this Act 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 Primary Care Trust or Local Health Board and the contractor or contractors in relation to—
(a) the services to be provided under the contract,
(b) remuneration under the contract, and
(c) any other matters.
(4) The services to be provided under a general medical services contract may include—
(a) services which are not primary medical services;
(b) services to be provided outside the area of the Primary Care Trust or Local Health Board.
(5) In this Part, "contractor", in relation to a general medical services contract, means any person entering into the contract with the Primary Care Trust or Local Health Board.
28R Requirement to provide certain primary medical services
(1) A general medical services contract must require the contractor or contractors to provide, for his or their patients, primary medical services of such descriptions as may be prescribed.
(2) Regulations under subsection (1) may in particular describe services by reference to the manner or circumstances in which they are provided.
28S Persons eligible to enter into GMS contracts
(1) A Primary Care Trust or Local Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with—
(a) a medical practitioner;
(b) two or more individuals practising in partnership where the conditions in subsection (2) are satisfied; or
(c) a company limited by shares where the conditions in subsection (3) are satisfied.
(2) The conditions referred to in subsection (1)(b) in relation to a partnership are that—
(a) at least one partner is a medical practitioner; and
(b) any partner who is not a medical practitioner is either—
(i) an NHS employee;
(ii) a section 28C employee or a section 17C employee;
(iii) a health care professional who is engaged in the provision of services under this Act; or
(iv) an individual who is providing services under a general medical services contract or a general dental services contract or in accordance with section 28C arrangements or arrangements under section 17C of the National Health Service (Scotland) Act 1978, or has so provided them within such period as may be prescribed.
(3) The conditions referred to in subsection (1)(c) in relation to a company are that—
(a) at least one share in the company is legally and beneficially owned by a medical practitioner; and
(b) any share which is not so owned is legally and beneficially owned by a person referred to in subsection (2)(b)(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.
(5) In this section—
"health care professional" has the same meaning as in section 28M above;
"NHS employee", "section 28C employee" and "section 17C employee" have the same meanings as in section 28D above.
28T GMS contracts: payments
(1) The appropriate authority may give directions as to payments to be made under general medical services contracts.
(2) A general medical services contract must require payments to be made under the contract in accordance with directions for the time being in force under this section.
(3) Without prejudice to the generality of the power under subsection (1), directions under that subsection may—
(a) provide for payments to be made by reference to compliance with standards or the achievement of levels of performance;
(b) provide for payments to be made by reference to—
(i) any scheme or scale specified in the direction; or
(ii) a determination made by any person in accordance with factors specified in the direction;
(c) provide for the making of payments in respect of individual practitioners;
(d) provide that the whole or any part of a payment is subject to conditions (and may provide that payments are payable by a Primary Care Trust or Local Health Board only if it is satisfied as to certain conditions);
(e) make provision having effect from a date before the date of the direction, provided that, having regard to the direction as a whole, the provision is not detrimental to the persons to whose remuneration it relates.
(4) Before giving a direction under subsection (1), the appropriate authority—
(a) must consult any body appearing to the authority to be representative of persons to whose remuneration the direction would relate, and
(b) may consult such other persons as the authority thinks appropriate.
(5) Section 18(1) and (3)(b) apply in relation to directions under this section.
(6) References in this section to payments include fees, allowances, reimbursements, loans and repayments.
(7) In this section "appropriate authority" means—
(a) the Secretary of State, in relation to a contract made by a Primary Care Trust;
(b) the National Assembly for Wales, in relation to a contract made by a Local Health Board.
28U GMS contracts: other required terms
(1) A general medical services contract must contain such provision as may be prescribed (in addition to the provision required by the preceding provisions of this Part).
(2) Regulations under subsection (1) may in particular make provision as to—
(a) the manner in which, and standards to which, services are to be provided;
(b) the persons who perform services;
(c) the persons to whom services are to be provided;
(d) the right of patients to choose the persons from whom they are to receive services;
(e) the variation of contract terms (other than terms required by or under this Part);
(f) rights of entry and inspection (including inspection of clinical records and other documents);
(g) the circumstances in which, and the manner in which, the contract may be terminated;
(h) enforcement;
(i) the adjudication of disputes.
(3) Regulations making provision under subsection (2)(c) may make provision as to the circumstances in which a contractor or contractors—
(a) must or may accept a person as a patient to whom services are provided under the contract; or
(b) may decline to accept a person as such a patient; or
(c) may terminate his or their responsibility for a patient.
(4) Regulations under subsection (2)(e) may—
(a) make provision as to the circumstances in which a Primary Care Trust or Local Health Board may impose a variation of contract terms;
(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 subsection (4)(b) may prescribe services by reference to the manner or circumstances in which they are provided.
(6) A general medical services contract must contain provision requiring the contractor or contractors to comply with any directions given by the appropriate authority for the purposes of this section as to the drugs, medicines or other substances which may or may not be ordered for patients in the provision of medical services under the contract.
(7) Section 18(1) and (3)(b) apply in relation to directions under subsection (6).
(8) In subsection (6) "appropriate authority" has the same meaning as in section 28T above.
28V GMS contracts: disputes and enforcement
(1) Regulations may make provision for the resolution of disputes as to the terms of a proposed general medical services contract.
(2) Regulations under subsection (1) may make provision—
(a) for the referral of the terms of the proposed contract to the Secretary of State or National Assembly for Wales; and
(b) for the Secretary of State or Assembly, or a person appointed by him or 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 service body for any purposes of section 4 of the National Health Service and Community Care Act 1990, in circumstances where he or they so elect.
(4) Regulations under subsection (3) may include provision as to the application of section 4 of that Act in cases where—
(a) persons practising in partnership elect to become a health service body; and
(b) there is a change in the membership of the partnership.
(5) Where—
(a) by virtue of regulations under subsection (3), subsection (7) of section 4 of that Act applies in relation to a general medical services contract, and
(b) a direction as to payments is made under that subsection in relation to the contract,
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."
(2) Sections 29 to 34A of the 1977 Act (arrangements for general medical services) shall cease to have effect.'—[Mr. Hutton.]
Brought up, read the First and Second time, and added to the Bill.