ANNEX A:: OUTLINE OF THE EXISTING LAW RELATING TO THE NHS Part 2 System: family health services Funding The Primary Care Act
508.The Primary Care Act introduced a new method of delivery of family health services. Personal medical services ("PMS") and personal dental services ("PDS") may be provided under agreements known (in the initial stage at least) as "pilot schemes" (sections 1-3 of the Primary Care Act). These agreements are made between the Strategic Health Authority or PCT and one or more of the persons or bodies listed in section 3(2). Before a pilot scheme may be made, the proposals for the scheme must be submitted to, and approved by, the Secretary of State (sections 4 and 5).
509.Although the provider of personal medical services may be an NHS trust or other qualifying body, the services themselves must be performed by a "suitably experienced" medical practitioner. Section 26 of the Health and Social Care Act 2001 amends the Primary Care Act by inserting a new section 8ZA, that provides powers to require the HA to keep a list of all the performers of PMS. The regulations have yet to be made.
510.The system of pilot schemes is intended ultimately to be replaced by a permanent regime, which is in substance the same as the pilot scheme regime but instead of being provided for in free standing provisions of the Primary Care Act is provided for by way of amendments to the 1977 Act. See sections 21 and 22 of the Primary Care Act which insert, in relation to England and Wales, sections 28C, 28D and 28E, which are not yet in force. All these provisions are prospectively further amended by the section 4 of and Schedule 3 to the NHS Reform Bill which devolve PMS and PDS functions from the Secretary of State and HAs to PCTs wherever practicable. Where the PCT is providing PMS or PDS rather than commissioning it, it is not considered compatible with maintaining a distinction between commissioner and provider to devolve certain functions to the PCT. In these cases, functions currently undertaken by the HA under the 1997 Act will remain at Strategic Health Authority level.
511.Pilot schemes allow PMS and PDS (essentially the same as GMS and GDS) to be provided under the Part I system. The provisions of the 1977 Act apply in relation to functions of the Secretary of State in relation to pilot schemes as if the functions were functions under Part I of the Act. NHS trusts may enter into a pilot scheme as a provider of PMS or PDS. The 1977 Act (and in particular section 17) has effect in relation to services under pilot schemes as if the services were provided as a result of delegation by the Secretary of State (by directions given under section 16D of that Act) of functions of his under Part I (section 9 of the Primary Care Act).
512.These provisions allow PMS to be provided otherwise than through the rigid regulatory system of Part 2 of the 1977 Act. They allow PCTs and HAs the power to determine locally the content of the service in their area or the practitioners with whom they choose to make the arrange­ments.
513.The PCT funds the services provided under a pilot scheme from its cash-limited allocation under section 97C. This means that in effect the remuneration of practitioners providing PMS or PDS under the Primary Care Act is cash-limited, in contrast to the remuneration of Part II practitioners.