Personal Health Services
The Health and Social Services Board may recognize local dental, optical, and pharmaceutical committees. Regulations may require the Board to consult with committees so recognized. The Board is to pay the expenses of a recognized committee. The Board may recognize local medical committees.
Committees are to have such functions as may be prescribed. The amount of their expenses is to be met by the Board. Each Board, to the extent it considers necessary to meet reasonable requirements, is to exercise its functions to provide primary medical services within its area or to secure the provision of primary medical services. It is to publish information about matters as may be prescribed in relation to primary medical services. Regulations may define what is and is not primary medical services.
The Boards may enter contracts with primary medical service providers.
A General Medical Services Contract. The general medical services contract shall require the contractors to provide primary medical services and other services of such descriptions as may be prescribed. Boards may, subject to conditions, enter into general medical services contracts with medical practitioners or partnerships or companies, with partnerships comprising medical practitioners, or certain other individuals in the health professions. They may enter contracts with companies, legally and beneficially owned by a medical practitioner or a medical practitioner and certain other persons of the medical profession.
The Department may give directions as to payments under general medical service contracts. They may provide for compliance with standards of performance. They may provide for payments to be made by reference to schemes or scales specified and determinations made by any person in accordance with factors specified in the direction.
They may provide for making payments in respect of individual practitioners; provide for payments subject to conditions.
Before making directions, the Department is to consult with representative bodies.
A general medical services contract shall contain provisions requiring the contractor to comply with the directions of the Department as to drugs, medicines, and other substances that may or may not be ordered for patients in the provision of medical services.
Regulations in relation to the content of a contract shall make provision for the manner and standards to which services are to be provided; persons to perform services; persons to whom they are to be provided; variation of contract terms; rights of entry and inspection; enforcement; adjudication of disputes.
They shall make provision for circumstances in which a contractor shall or may accept a person as a patient, may decline to accept a person or may terminate his or her responsibility for a patient.
They may make provision for the resolution of disputes as to the terms of a proposed general medical services contract. They may make provision for the reference of disputes to a person appointed by the Department.
Regulations may provide that a healthcare professional of a prescribed description may not perform primary medical services for which a Board is responsible unless they are included in the list maintained by regulations under the Board.
The regulations may provide for the preparation and publication of a list, applications for inclusion, eligibility, grounds for grant or refusal, requirements for qualification in the list, suspension and removal, and references to a tribunal in relation to the same.
Health and Social Services Board may provide assistance and support to any person providing or proposing to provide primary medical services under a general medical service contract.
There are prohibitions on the sale or compensation for the loss of the right to sell medical practices. The sale of the goodwill of a medical practice is restricted.
The Boards are to make arrangements for general dental services in the same way as with respect to general medical services. The Department is to prepare, publish, and maintain lists of dental practitioners who provide general dental services. Charges may be made in respect of certain extra costs or supply. There are provisions for entry on the list and appeals against refusal.
The Boards are to provide general ophthalmic services to children and other persons falling within the regulations, as being entitled to the same. There is provision for a list of ophthalmic opticians equivalent to those for doctors and dentists.
Regulations may be made prescribing entitlement to the services and charges where applicable. They may be made by reference to income, capital.
The Boards are to provide pharmaceutical services so that proper and sufficient drugs and medicines and listed appliances that are ordered by medical practitioners are available. Regulations may provide for the terms on which drugs, medicines, and appliances are to be provided.
As with other medical professions, lists are to be provided for persons who undertake pharmaceutical services. There are provisions for applications for entry on the list, approval, removal, suspension, etc.
The Department may publish and establish a Drug Tariff.
Regulations may provide that practitioners must hold indemnity cover. This may be made a condition of entry on any approved list. There are regulations regarding the terms of cover that must be held.
There are restrictions on the sale of the goodwill of medical practices of persons who have provided primary medical services or personal medical services under the legislation unless the person no longer provides or performs such service or never has carried on practice in the Board’s area.
Certain transactions are deemed to be the sale of goodwill.
A Tribunal is constituted in relation to applications for inclusion and disqualification from the list. A Tribunal may inquire into matters arising from exclusion or disqualification from the list.
Where the Health and Social Services Board seeks to disqualify a person from the list on the basis of their presence on the list, inclusion being prejudicial to the efficacy of services or has, whether in their own or together with another, by act or omission caused a risk causing detriment to any health scheme by securing for themselves or another a financial benefit which they know they or the other were not entitled to.
The Tribunal acts in relation to the list of medical practitioners, dental practitioners, ophthalmic opticians, and persons providing pharmaceutical services.
The inquiry may inquire into matters relating to disqualification and may make a local or general disqualification, provided that it is not unjust to do so.
The Tribunal may review any disqualification, conditional disqualification, or declaration of unfitness. If the Board requests a review of conditional disqualification on the ground of change in circumstances or failure of compliance conditions, it shall review the conditional disqualification. On review, it may remove, vary, or make a conditional disqualification unconditional.
A person aggrieved by the determination of a Tribunal may appeal to the Court of Appeal in accordance with rules of court.
There are provisions for applications for interim suspension and suspension pending appeal.
The Tribunal shall consist of a chairman appointed by the Lord Chief Justice; such a number of deputy chairmen as the Lord Chief Justice appoints; and such other number of persons as the Department may appoint; or persons, medical practitioners, dental practitioners, pharmaceutical practitioners, and ophthalmic opticians, as the Department may appoint.
The functions of the Tribunal are exercised by the chairman, persons appointed by the Department, and persons appointed by the same professional group as the person concerned.