Contract Monitorin G Guide: Managing the Performance of Primary Care Dental Contracts s1

Changes to APMS Directions from 2004 to April 2012

April 2012

Alternative Provider Medical Services Directions Directions in force from 22 April 2004 to 14 April 2005

Differences from preceding Directions are highlighted (in yellow). See the corresponding documents (click to open).

APMS Directions 2004

Adobe Acrobat Document Directions (Page 1) Footnotes (c) SI 2004/291 as amended by SI 2004/906. (e) SI 2004/627 as amended by SI 2004/906.

SI - 2004/291 with effect from 1 March 2004 These Regulations set out, for England, the framework for general medical services contracts under section 28Q of the National Health Service Act 1977 (the Act).

Part 2 of the Regulations prescribes the conditions which, in accordance with section 28S of the Act, must be met by a contractor before the Primary Care Trust may enter into a general medical services contract with it.

Part 3 of the Regulations prescribes the procedure for pre-contract dispute resolution, in accordance with section 28W(2) of the Act. Part 3 applies to cases where the contractor is not a health service body. In cases where the contractor is such a body, the procedure for dealing with pre-contract disputes is set out in section 4 of the National Health Service and Community Care Act 1990.

Part 4 of the Regulations sets out the procedures, in accordance with section 28W(3) of the Act, by which the contractor may obtain health service body status.

Part 5 of (and Schedules 2 to 6, and 8 to 10 to) the Regulations prescribe the terms which, in accordance with sections 28V and 28W of the Act, must be included in a general medical services contract (in addition to those contained in the Act). It includes, in regulation 15, a description of the services which must be provided to patients under general medical services contracts pursuant to section 28R of the Act.

The prescribed terms include terms relating to

a. the type and duration of the contract (regulations 12 to 14);

www.pcc-cic.org.uk © PCC April 2012 1 Changes to APMS Directions from 2004 to April 2012

b. the services to be provided (regulations 15, 16 and 18 to 20 and Schedule 2), the manner in which they are to be provided (Part 1 of Schedule 6) and the procedures for opting out of additional and out of hours services (regulation 17 and Schedule 3); c. the issuing of medical certificates (regulation 21 and Schedule 4); d. finance, fees and charges (regulations 22 to 24 and Schedule 5); e. patient registration and removal, lists closures and assignments (Schedule 6, Part 2, and Schedule 8); f. prescribing and dispensing (Schedule 6, Part 3); g. the conditions to be met by those who perform services or are employed or engaged by the contractor (Schedule 6, Part 4); h. patient records, the provision of information and rights of entry (Schedule 6, Part 5, and Schedule 10); i. complaints (Schedule 6, Part 6); j. procedures for dispute resolution (Schedule 6, Part 7); and k. procedures for variation and termination of contracts (Schedule 6, Part 8).

Part 6 of the Regulations prescribes functions for local medical committees. Part 7 of the Regulations and Schedule 7 make transitional provision.

SI – 2004/627 with effect from 1 January 2004

These Regulations set out, for England, the framework for personal medical services agreements under section 28C of the National Health Service Act 1977 (the Act).

Part 2 of the Regulations prescribes the conditions which, in accordance with section 28D of the Act, must be met by a contractor before the relevant body may enter into a personal medical services agreement with it.

Part 3 of the Regulations prescribes the procedure for pre-agreement dispute resolution, in accordance with section 28E(3D) of the Act. Part 3 applies to cases where the contractor is not a health service body. In cases where the contractor is such a body, the procedure for dealing with pre-agreement disputes is set out in section 4 of the National Health Service and Community Care Act 1990 (the 1990 Act).

Part 4 of the Regulations provides for a contractor to be a health service body for the purposes of section 4 of the 1990 Act unless it objects by serving a notice on the relevant body before the agreement is made.

Part 5 of (and Schedules 2 to 5, and 7 to 10 to) the Regulations prescribe the terms which, in accordance with section 28E of the Act, must be included in a personal medical services agreement.

The prescribed terms include terms relating to -

a. the type of agreement (regulation 10); b. the manner in which services are to be provided (Part 1 of Schedule 5) and the procedures for opting out of out of hours services (regulation 16 and Schedule 4); c. the issuing of medical certificates (regulation 12 and Schedule 2); d. finance, fees and charges (regulations 13 to 15 and Schedule 3); e. patient registration and removal, list closures and assignments (Schedule 5, Part 2 and Schedules 7 and 8); f. prescribing and dispensing (Schedule 5, Part 3 and Schedule 9); g. the conditions to be met by those who perform services or are employed or engaged by the contractor (Schedule 5, Part 4);

h. patient records, the provision of information and rights of entry (Schedule 5, Part 5 and Schedule 10); i. complaints (Schedule 5, Part 6); j. procedures for dispute resolution (Schedule 5, Part 7); and k. procedures for variation and termination of agreements and consequences of termination of the agreement (regulation 17 and Schedule 5, Part 8).

Part 6 of the Regulations provides for a contractor to terminate its agreement and enter into a general medical services contract. Part 7 of the Regulations and Schedule 6 makes transitional provision

SI - 2004/906 with effect from 1 April 2004 These Regulations restrict the sale of goodwill by certain primary medical services performers or providers in all circumstances. They also, in effect, prohibit certain forms of subcontracting of clinical services by general medical services and personal medical services contractors.

APMS Directions (No.2) 2004

Adobe Acrobat Document

Directions (Page 2) Footnote (a) SI 2004/ 627 as amended by SI 2004/906 and 2694.

SI - 2004/2694 with effect from 15 November 2004 These Regulations make amendments to certain regulations relating to primary medical services. Amendments are made to the National Health Service (General Medical Services Contracts) Regulations 2004 (the GMS Contracts Regulations). In particular it - widens the definition of general medical practitioner in regulation 2 of the GMS Contracts Regulations to cover all medical practitioners who are included in the General Practitioner Register or who, prior to coming into force of that Register, are suitably experienced within the meaning of section 31 of the National Health Service Act 1977 (the 1977 Act) or have an acquired right to practise;

 restricts the categories of general medical practitioner who, under regulation 4 of the GMS Contracts Regulations, can act as the mandatory medical practitioner for the purposes of a general medical services contract. It excludes from that role practitioners who, prior to 1st April 2004 were restricted services principals or who were not considered to be suitably experienced for the purposes of operating as a Principal in the provision of general medical services under section 29 of the 1977 Act;  disapplies the provisions relating to clinical reports in the case of out of hours services which are covered by the quality requirements referred to in regulation 5(3);  amends paragraph 31 of Schedule 6 to the GMS Contracts Regulations to enable a contractor's list of patients which has been closed as a result of a determination by an assessment panel to re-open by agreement before the end of the closure period specified by that panel and, in certain circumstances, to re-close again during that period;  amends the circumstances in paragraph 53 of Schedule 6 to the GMS Contracts Regulations in which a GP Registrar can perform medical services under a contract without being included in a medical performers list. It brings them into line with those in regulation 22(3) of the National Health Service (Performers Lists) Regulations 2004;  removes the requirement in paragraph 64 of Schedule 6 to the GMS Contracts Regulations for the Secretary of State to consent to the employment of a GP Registrar;  inserts in paragraph 77 of Schedule 6 to the GMS Contracts Regulations a timescale for the provision of information by contractors to the Primary Care Trust;  clarifies the timescale for the submission of annual returns under paragraph 81 of Schedule 6 to the GMS Contracts Regulations;  disapplies the provision relating to the provision of information about complaints in the case of out of hours services which are covered by the quality requirements referred to in paragraph 11 of Schedule 6 (as amended by these Regulations);  amends paragraph 122 of Schedule 6 to the GMS Contracts Regulations to provide that, for the purpose of meeting its obligation of holding adequate insurance, a contractor can rely on insurance held by a person engaged by it as well as by an employee.

Directions (Page 5) Footnotes (b) A reference to paragraph 69(3) was substituted for the reference to paragraph 70(3) in paragraph 98(1) of the PMS Agreements Regulations by SI 2004/2694, regulation 15(17). (c) The reference to regulations 4 and 5 in paragraph 104 of the PMS Agreements Regulations was amended to refer to regulation 5 only by SI 2004/2694, regulation 15(19).

Directions (Page 6) Footnote (a) Paragraph 106A was inserted into the PMS Agreements Regulations by SI 2004/906

SI - 2004/906 with effect from 1 April 2004 These Regulations restrict the sale of goodwill by certain primary medical services performers or providers in all circumstances. They also, in effect, prohibit certain forms of subcontracting of clinical services by general medical services and personal medical services contractors.

Directions (Page 8) Footnote (a) The document “Quality Standards in the delivery of GP Out of Hours Services” is published on the Department of Health’s website at www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance or a copy may be obtained by writing to Primary Care, Room 4N34E, Department of Health, Quarry House, Quarry Hill, Leeds LS2 7UE..

Directions (Page9) Footnote (a) The document “National Quality Requirements in the Delivery of Out of Hours Services” published on 14th October 2004 is published electronically at www.out-of-hours-info or a copy may be obtained by writing to Primary Care, Room 4N34E, Department of Health, Quarry House, Quarry Hill, Leeds LS2 7UE.

APMS Directions (No.2) 2004 PCTMS (No.2) Directions 2004 Summary of Amendments

Directions (Page 2) Footnotes (a) SI 2004/291 as amended by SI 2004/906 and 2694 and SI 2005/28 and SI 2005/893 (d) SI 2004/ 627 as amended by SI 2004/906 and 2694 and S.I, 2005/28 and SI 2005/893

SI - 2005/28 with effect from 13 January 2005

Schedule 9 contains lists of Primary Care Trusts which are specified for the purposes of repeatable prescribing or repeat dispensing. This list wrongly included a reference to Leicester Primary Care Trust which does not exist. These Regulations substitute a correct reference to Leicester City West Primary Care Trust which is one of two Primary Care Trusts in Leicester.

SI - 2005/893 with effect from 14 April 2005

These Regulations make amendments to certain regulations relating to primary medical services, in particular, it:

a. provides for the introduction of electronic prescribing Part 1, Schedule 6 - Part 3 b. makes amendments consequential on the repeal of the National Health Service (Pharmaceutical Regulations) 1992 and their replacement by the National Health Service (Pharmaceutical Regulations) 2005 Part 1, Schedule 6 - Part 3; c. replaces references to the National Clinical Assessment Authority (which will cease to exist on 31st March 2005) with references to the National Patient Safety Agency Part 1, Schedule 6 - Part 4; d. amends the definition of supplementary prescriber to include further health professionals Part 1; e. bans the use of telephone services for the purposes of general medical services contracts which make use of national rate numbers (starting with 087), premium rate numbers (starting with 090) or personal numbers starting with 070 Schedule 6 - 1A; f. inserts provisions to enable the supply of medicines to patients by providers of out of hours services where certain conditions are met (Schedule 6 - 11A); g. extends the requirements for supply by instalments to diazepam Schedule 6 - Part 3; h. removes the requirement that contractors can only provide repeatable prescribing services if they hold a contract with specified Primary Care Trusts. Schedule 9 (Primary Care Trusts specified for the purposes of repeatable prescribing) omitted. Schedule 6 - Part 3. i. removes the restrictions preventing supplementary prescribers from prescribing controlled drugs or unlicensed medicines Schedule 6 - Part 3; j. removes the provision relating to the Quality Information Preparation Scheme which will cease to exist on 31st March 2005 Schedule 6 - Part 5; k. requires contractors who are companies limited by shares to notify the Primary Care Trust of a change of director or secretary and enables the Primary Care Trust to terminate the contract if untrue information is given about the compliance of that director or secretary with the conditions in regulation 5 of the GMS Contracts Regulations Schedule 6 - Part 5, Schedule 6 - Part 8;

l. enables a Primary Care Trust to vary a contract to allow it to continue at least for an interim period after the death of partner in a two-handed partnership even where the remaining individual is not a medical practitioner Schedule 6 - Part 8; m. provides that a contract with an individual medical practitioner shall terminate seven days after that practitioner's death unless before then arrangements have been made for it to continue for a further short period Schedule 6 - Part 8; n. enables a Primary Care Trust to continue a contract for a limited period with a medical practitioner who no longer meets the conditions in regulation 4 of the GMS Contracts Regulations if:

i. the reason for that failure is an immediate or interim suspension or health suspension under the Medical Act 1983, ii. adequate arrangements are in place to provide clinical services during the period of suspension, and iii. immediate termination is not necessary on grounds of patient safety or to protect public funds Schedule 6 - Part 8;

o. clarifies that the grounds for termination of the contract in paragraph 113 of Schedule 6 to the GMS Contracts Regulations only apply to partners, shareholders and directors who join the contracting body after the start of the contract in respect of circumstances which arise after they have so joined (prior circumstances being covered by paragraphs 85, 86 and 112 of that Schedule) Schedule 6 - Part 8.

Directions (Page 6) Footnotes (a) Paragraph 2A was inserted into Schedule 5 to the PMS Agreements Regulations by SI 2005/893 (b) Paragraphs 38A and 38B were inserted into Schedule 5 to the PMS Agreements Regulations by SI 2005/893

Directions (Page 7) Footnote (a) Paragraph 99A was inserted into Schedule 5 to the PMS Agreements Regulations by SI 2005/893

Directions (Page 8) Footnote (a) The National Patient Safety Agency is established as a Special Health Authority by the National Patient Safety Agency (Establishment and Constitution) Order 2001 (SI 2001/1743).

Alternative Provider Medical Services Directions

Directions in force from 6 January 2006 to 14 April 2010

APMS (N0.2) Directions 2005

Adobe Acrobat Document Directions (Page 6) Footnotes Footnote “(c ) Paragraph 66 was amended by SI 2005/3315 to provide that certain forms do not need to include the name of the contractor on whose behalf the form was signed”.

SI 2005/3315 with effect from 6 January 2006 These Regulations make amendments to certain regulations relating to primary medical services. They amend the National Health Service (General Medical Services Contracts) Regulations 2004 (the GMS Contracts Regulations). In particular, it:

a. makes provision in relation to batch issues and repeatable prescriptions; b. provides that provisions that relate to a spouse will also relate to a civil partner; c. amends the definition of a supplementary prescriber to add optometrists to the list of those who may be so recognised; d. provides that a contract may be entered into with a person notwithstanding the fact that they have been removed from office as a trustee for a charity, provided such removal did not take place within the previous 5 years; e. amends the provision relating to payments under a GMS contract to clarify that payments should be made by either party in accordance with any relevant directions; f. amends the provisions of Schedule 6 of the GMS Contracts Regulations regarding the provision of dispensing services by contractors; g. updates the reference to the good practice document to which contractors must have regard in connection with patient records.

Footnote “(d) Paragraph 69(5) was inserted into Schedule 5 to the PMS Agreements Regulations by SI 2004/906”.

These Regulations restrict the sale of goodwill by certain primary medical services performers or providers in all circumstances. They also, in effect, prohibit certain forms of subcontracting of clinical services by general medical services and personal medical services contractors.

APMS (Amendment) Directions 2006

Adobe Acrobat Document Directions (Page 2) Footnotes (a) SI 2004/291 as amended by SI 2004/906 and 2694, SI 2005/28, 893 and 3315 and SI 2006/1501. (e) The definition of “prescriber” was amended by SI 2006/1501 to include reference to a pharmacist independent prescriber

Directions (Page 6) Footnote (c) Paragraph 53 was amended by SI 2006/1501 to make provision in relation to those undertaking a programme of post-registration supervised clinical practice.

SI - 2006/1501 with effect from 24 July 2006 Amendments are made to certain Regulations relating to primary medical services. In particular:

a. amendments to reflect changes to the arrangements for independent prescribing by pharmacists and nurses. There is to be a new category of prescriber known as a Pharmacist Independent Prescriber, and new arrangements for independent prescribing by nurses – which require consequential amendments to the titles of nurses who have trained to prescribe; (Also see Schedule 6)

b. provision in respect of a new category of post graduate medical training to provide that doctors undergoing such a programme may perform medical services even though they are not on a PCT's Performers List and have not provided two clinical references

Directions (Page 2) Footnotes (b) SI 2004/ 627 as amended by SI 2004/906 and 2694, SI 2005/28, 893 and 3315, SI 2006/1501 and SI 2007/3491. (c) the definition of “prescriber” was amended by SI 2006/1501 to include reference to a pharmacist independent prescriber. (d) the NHS Business Services Authority is a Special Health Authority established by the NHS Business Services Authority (Awdurdod Gwasanaethau Busnes y GIG) (Establishment and Constitution) Order 2005 [SI 2005/2414].

SI - 2007/3491 with effect from 28 January 2008

These Regulations make amendments to certain Regulations relating to primary medical services.

Amendments are made as follows:

a. updates to the definitions of batch issue and repeatable prescription; b. changes relating to the method by which home oxygen services may be ordered; Home oxygen order form and Home oxygen services c. amendments to references to “incapable adults”, and to those who may act on their behalf, to reflect the terms used in and the provisions of the Mental Capacity Act 2005; d. amendments to the provisions relating to the contractor’s clinical governance system to provide that such systems must include standard operating procedures in relation to the management and use of controlled drugs and also makes amendments which require contractors to co-operate in the discharge of any obligations of the Primary Care Trust or its accountable officer in relation to the management and use of controlled drugs; and e. minor changes to the restrictions on those who are eligible to contract to provide primary medical services and to the provisions relating to the service of remedial and breach notices.

SI - 2006/1501 with effect from 24 July 2006 Amendments are made to certain Regulations relating to primary medical services. In particular:

b. amendments to reflect changes to the arrangements for independent prescribing by pharmacists and nurses. There is to be a new category of prescriber known as a Pharmacist Independent Prescriber, and new arrangements for independent prescribing by nurses – which require consequential amendments to the titles of nurses who have trained to prescribe; (Also see Schedule 6)

b. provision in respect of a new category of post graduate medical training to provide that doctors undergoing such a programme may perform medical services even

though they are not on a PCT's Performers List and have not provided two clinical references

Directions (Page 3) Footnotes (a) The overprint specification can be found at www.ppa.org.uk/ppa/prescform_overspec.htm

Directions (Page 2) Footnotes (a) SI 2004/291 as amended by SI 2004/906 and 2694, SI 2005/28, 893, 3315 and 3491, SI 2006/1501 and SI 2007/3491, SI 2008/528, 1514 and 1700, SI 2009/309, 2205 and 2230. (d) SI 2004/ 627 as amended by SI 2004/906 and 2694, SI 2005/28, 893, 3315 and 3491, SI 2006/1501, SI 2007/3491, SI 2008/528, 1514 and 1700, SI 2009/309, 2205 and 2230.

SI- 2008/528 with effect from 1 April 2008

Consequential amendments are made relating to the abolition of Patients’ Forums and the Commission for Public and Patient Involvement in Health and the establishment of local involvement networks and also amend a reference to a Community Health Council.

SI - 2008/1514 with effect from 14 July 2008

These amendments relate to the duty of persons providing such services to allow entry under regulation 3 of the Local Involvement Networks (Duty of Services-Providers to Allow Entry) Regulations 2008, which imposes a duty on certain providers of health or social care (services-providers) to allow local involvement networks to enter and view certain premises owned or controlled by them.

These Regulations are amended to provide that a contract, agreement or scheme governed by those regulations must include a term which requires the relevant contractor to comply with regulation 3 of the Entry Regulations, in so far as it applies to the contractor

SI - 2008/1700 with effect from 1 August 2008

Minor and consequential amendments made relating to the new arrangements from 1st August 2008 for the provision of general ophthalmic services under section 115 of the National Health Service Act 2006 in respect of general ophthalmic services contracts entered into under section 117 of that Act.

Consequential and transitional amendments relating to complaints about services provided by certain providers of health care. Amendments have been made to Schedule 6, Part 6 - paragraph 92 (Complaints Procedure), paragraph 97 (Co-operation with investigations) and paragraphs 93 - 96 and 98 are omitted.

SI - 2009/2205 with effect from 17 September 2009

The Regulations are amended to contain measures to allow retail pharmacies and dispensing doctors that are entitled to dispense against NHS prescriptions to dispense

www.pcc-cic.org.uk © PCC April 2012 13 Changes to APMS Directions from 2004 to April 2012 against prescriptions issued by an optometrist who is qualified to order drugs, medicines and appliances as an optometrist independent prescriber. Part 1 (General) – 2 (interpretation)

These Regulations are amended so that during outbreaks of pandemic influenza, orders for the same two antiviral medicines for patients aged 13 and over can be written either on a new voucher or on the standard prescription form (in the latter case, with the endorsement “ACP”), where these medicines are being ordered by qualified prescribers under arrangements made by the Secretary of State or a Primary Care Trust for the distribution of these medicines free of charge. However, a qualified prescriber must use the new voucher for an order under those arrangements, if the order is for a patient aged 12 or under. Amendments are also made to provide for the ordering of these medicines by authorised people who are not qualified prescribers, if they are following criteria which enable them to do so and which are set under the arrangements for free distribution. However, any people ordering these medicines who are not qualified prescribers must use the new voucher rather than the standard prescription form. Schedule 6 (Other contractual terms) - Part 3 (Prescribing and Dispensing) 38, 39, 42 and 43

Directions (Page 6) Footnote (d) Paragraphs 41 and 42 were amended by SI 2009/2230 to make provision inn relation to listed medicines and listed medicines vouchers.

Directions (Page 7) Footnote (d) Paragraph 84 was omitted by SI 2008/528 and paragraph 85A was inserted by SI 2008/1514.

Directions (Page 3) Footnote (c) SI 2004/291 as amended by SI 2004/906 and 2694, 2005/28, 893, 3315 and 3491, 2006/1501, 2007/3491, 2008/528, 1514 and 1700, 2009/309, 2205 and 2230 and 2010/22, 234 and 578.

This Order is made under the Tribunals, Courts and Enforcement Act 2007 (“the 2007 Act”). Part 1 of the 2007 Act creates a new two tier tribunal structure; the First-tier Tribunal and the Upper Tribunal are established under section 3 of the 2007 Act. Order making powers are provided under Part 1 of the 2007 Act to enable existing tribunals to be transferred into the new structure. This Order effects the transfer into the new structure of various tribunal functions.

Amendments to these Regulations are as a consequence of the transfers effected by this Order.

The main amendments made are references to the “FHSAA” substituted by “First-tier Tribunal”.

SI - 2010/234 made 10 February 2010

This Order provides for the abolition of the Postgraduate Medical Education and Training Board (“the Board”) which was established by General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003 (SI2003/1250) (“the 2003 Order”). It provides for the transfer of its functions relating to postgraduate medical education and training for specialist medical practice and general medical practice to the General Medical Council (“GMC”).

Amendments to Regulation 2 (Interpretation) as a consequence of the abolition of the Family Health Services Appeal Authority by the Transfer of Tribunal Functions Order 2010 (SI 2010/22);

Amendment to Regulation 4 (Conditions relating solely to medical practitioners) as a consequence of the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010 (SI 2010/234) and the Postgraduate Medical Education and Training Order of Council 2010 (SI 2010/473);

Amendments to Regulation 5 (General condition relating to all contracts) updates references to the provisions relating to removal of a person being concerned in the management or control of a charity or body as a consequence of the Charities and Trustee Investment (Scotland) Act 2005;

Amendment to Regulation 21 (Certificates) as a consequence of the introduction in the Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) Regulations 2010 (SI 2010/137) of new rules relating to medical evidence; Amendments to Schedule 6 (Other Contractual Terms):-

Insertion of new paragraph (Cost of relevant calls) regarding provisions in respect of the use of certain telephone numbers which charge patients more than the equivalent cost of calling a geographical number;

Amendment to paragraph 11 (Standards for out of hours services) updating the reference to requirements which a contractor must comply with in providing out of hours services;

SI - 2010/578 with effect from 1 April 2010 continued Amendment of erroneous reference in paragraph 20 (Removal from the list at the request of the contractor)

Amendment to paragraph 73 (Patient records) which updates the reference to the requirements in respect of a contractor’s computer system;

Substitution for paragraph 80 (Provision of information to a medical officer etc.) which makes changes to the arrangements under which contractors must disclose information (with the consent of the patient) in connection with claims for benefits;

Amendment of paragraph 91 (Entry and inspection by the Commission for Healthcare Audit and Inspection) updating certain statutory references in relation to entry and inspection; and

Amendment of paragraph 113 (Other grounds for termination by the Primary Care Trust) updating references to the provisions relating to removal of a person being concerned in the management or control of a charity or body as a consequence of the Charities and Trustee Investment (Scotland) Act 2005.

Directions (Page 8) Footnotes (b) Paragraph 2B was inserted by SI 2010/578. (g) Paragraphs 41 and 42 were amended by SI 2005/893; and by 2009/2230 to make provision in relation to listed medicines and listed medicines vouchers. (h) Paragraph 43 was amended by SI 2005/893. (k) Paragraph 63 was amended by SI 2004/2694.

These Regulations make amendments to certain regulations relating to primary medical services, in particular, it:

o. provides for the introduction of electronic prescribing Part 1, Schedule 6 - Part 3 p. makes amendments consequential on the repeal of the National Health Service (Pharmaceutical Regulations) 1992 and their replacement by the National Health Service (Pharmaceutical Regulations) 2005 Part 1, Schedule 6 - Part 3; q. replaces references to the National Clinical Assessment Authority (which will cease to exist on 31st March 2005) with references to the National Patient Safety Agency Part 1, Schedule 6 - Part 4; r. amends the definition of supplementary prescriber to include further health professionals Part 1;

www.pcc-cic.org.uk © PCC April 2012 16 Changes to APMS Directions from 2004 to April 2012 bans the use of telephone services for the purposes of general medical services contracts which make use of national rate numbers (starting with 087), premium rate numbers (starting with 090) or personal numbers starting with 070 Schedule 6 - 1A;

These Regulations are amended so that during outbreaks of pandemic influenza, orders for the same two antiviral medicines for patients aged 13 and over can be written either on a new voucher or on the standard prescription form (in the latter case, with the endorsement “ACP”), where these medicines are being ordered by qualified prescribers under arrangements made by the Secretary of State or a Primary Care Trust for the distribution of these medicines free of charge. However, a qualified prescriber must use the new voucher for an order under those arrangements, if the order is for a patient aged 12 or under.

Amendments are also made to provide for the ordering of these medicines by authorised people who are not qualified prescribers, if they are following criteria which enable them to do so and which are set under the arrangements for free distribution. However, any people ordering these medicines who are not qualified prescribers must use the new voucher rather than the standard prescription form.

Schedule 6 (Other contractual terms) - Part 3 (Prescribing and Dispensing) 38, 39, 42 and 43

SI - 2004/2694 with effect from 15 November 2004

These Regulations make amendments to certain regulations relating to primary medical services.

Amendments are made to the National Health Service (General Medical Services Contracts) Regulations 2004 (the GMS Contracts Regulations). In particular it -

 widens the definition of general medical practitioner in regulation 2 of the GMS Contracts Regulations to cover all medical practitioners who are included in the General Practitioner Register or who, prior to coming into force of that Register, are suitably experienced within the meaning of section 31 of the National Health Service Act 1977 (the 1977 Act) or have an acquired right to practise;  restricts the categories of general medical practitioner who, under regulation 4 of the GMS Contracts Regulations, can act as the mandatory medical practitioner for the purposes of a general medical services contract. It excludes from that role practitioners who, prior to 1st April 2004 were restricted services principals or who were not considered to be suitably experienced for the purposes of operating as a Principal in the provision of general medical services under section 29 of the 1977 Act;  disapplies the provisions relating to clinical reports in the case of out of hours services which are covered by the quality requirements referred to in regulation 5(3);  amends paragraph 31 of Schedule 6 to the GMS Contracts Regulations to enable a contractor's list of patients which has been closed as a result of a determination by an assessment panel to re-open by agreement before the end of the closure period specified by that panel and, in certain circumstances, to re-close again during that period;  amends the circumstances in paragraph 53 of Schedule 6 to the GMS Contracts Regulations in which a GP Registrar can perform medical services under a contract

without being included in a medical performers list. It brings them into line with those in regulation 22(3) of the National Health Service (Performers Lists) Regulations 2004;  removes the requirement in paragraph 64 of Schedule 6 to the GMS Contracts Regulations for the Secretary of State to consent to the employment of a GP Registrar;  inserts in paragraph 77 of Schedule 6 to the GMS Contracts Regulations a timescale for the provision of information by contractors to the Primary Care Trust;  clarifies the timescale for the submission of annual returns under paragraph 81 of Schedule 6 to the GMS Contracts Regulations;  disapplies the provision relating to the provision of information about complaints in the case of out of hours services which are covered by the quality requirements referred to in paragraph 11 of Schedule 6 (as amended by these Regulations);  amends paragraph 122 of Schedule 6 to the GMS Contracts Regulations to provide that, for the purpose of meeting its obligation of holding adequate insurance, a contractor can rely on insurance held by a person engaged by it as well as by an employee.

Personal Medical Services Agreements

Personal Medical Services Agreements Regulations 2004 (SI 2004/627) require that all agreements must contain provisions that have the same effect as the mandatory provisions that are contained in the Regulations as amended by:

 National Health Services (Primary Medical Services) (Miscellaneous Amendments) Regulations 2004 (SI 2004/2694),  National Health Service (Primary Medical Services) (Miscellaneous Amendment) Regulations 2005 (SI 2005/893),  National Health Service (Primary Medical Services) (Miscellaneous Amendments) (No. 2) Regulations 2005 (SI 2005/3315),  National Health Service (Primary Medical Services and Pharmaceutical Services) (Miscellaneous Amendments) Regulations 2006 (SI 2006/1501),  Pharmacists and Pharmacy Technicians Order 2007  National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2007 (2007/3491),  Local Involvement Networks Regulations 2008,  Local Involvement Networks (Miscellaneous Amendments) Regulations 2008,  Primary Ophthalmic Services Amendment, Transitional and Consequential Provisions Regulations 2008,  Local Authority Social Services and National Health Service Complaints (England) Regulations 2009,  National Health Service (Prescribing and Charging Amendments Relating to Pandemic Influenza) Regulations 2009,  National Health Service (Miscellaneous Amendments Relating to Community Pharmaceutical Services and Optometrist Prescribing) Regulations 2009,  Transfer of Tribunal Functions Order 2010,  the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2010;  National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2010 and  Pharmacy Order 2010.