ANNEX A:: OUTLINE OF THE EXISTING LAW RELATING TO THE NHS Part 2 System: family health services General Medical Services
489.Under section 29 of the 1977 Act, it is the duty of each PCT (or HA in Wales) in accordance with regulations to arrange as respects their area with medical practitioners to provide “personal medical ser­vices” for all persons in the area who wish to take advantage of the arrange­ments. These services are described as “general medical services” (“GMS”). A principal feature of this system is that (apart from certain exceptional cases) it is not the PCT or HA which itself provides the GMS; instead, it enters into separate statu­tory arrange­ments with inde­pendent practi­tioners (often known as “GP principals”) for the provision of those services. GPs are therefore not employees of the PCT or HA; they are inde­pen­dent pro­fessionals who undertake to provide GMS in accord­ance with the body of regulations governing that activ­ity. Those Regulations are currently the National Health Service (Gen­eral Medical Services) Regula­tions 1992 (S.I. 1992/635) as amended (“the GMS Regula­tions”). They incorporate (at Schedule 2) the Terms of Service of GP principals.
490.The remainder of section 29, as amended, sets out certain things which must or may appear in the Regulations. Section 29 is prospectively amended by section 23 Health and Social Care Act 2001. Section 29A prevents a PCT or HA making arrangements with a doctor unless he is on a medical list, and sets out certain restrictions on who is eligible to be on such a list. Section 29B gives a regulation-making power for the filling of vacancies for doctors which was also extended by section 20 of the Health and Social Care Act 2001. Sections 31 and 32 provide for regulations requiring that each GP must be “suitably experienced” as prescribed. Section 33 provides the Secretary of State with power to control GP numbers if necessary.
491.A new power for Regulations to enable PCTs or HAs to conditionally include doctors in the medical list is in section 43ZA, inserted into the 1977 Act by section 21 of the Health and Social Care Act 2001. Similar provision is made for all the professions. Section 43D inserted by section 24 of the Health and Social Care Act 2001 gives power in regulations for PCTs or HAs to keep lists of persons who assist in the provision of General Medical Services (in contrast to GP principals, who are included in the medical list) (see the National Health Service (Supplementary List) Regulations 2001 (SI 2001/3740) as amended). Similar provision is made for the other professions.
492.Section 28F inserted by the Primary Care Act gives power to make Regulations conferring a right to choose one’s medical practitioner (see the Choice of Medical Practitioner Regulations 1998, SI 1998/3179 as amended).
493.GPs are required by the Terms of Service to provide patients with personal medical services in effect at all times, but some provision is made in respect of out of hours services (see paragraphs 12 and 18A of Schedule 2 to the General Medical Services Regulations). Section 18 of the Health and Social Care Act 2001 allows for further formalisation of out of hours arrangements.
494.The broad structure of the Part 2 system is similar for dentists, opticians, and chemis­ts, but there are significant differences, most notably relating to chemis­ts and opticians.