NATIONAL HEALTH SERVICE, SCOTLAND Citation, commencement and interpretation 1 1 These Regulations may be cited as the National Health Service (Choice of Medical Practitioner) (Scotland) Regulations 1998 and shall come into force on 1st April 1998. 2 In these Regulations, unless the context otherwise requires– a “the 1978 Act ” means the National Health Service (Scotland) Act 1978; “the 1997 Act ” means the National Health Service (Primary Care) Act 1997 ; “doctor” means a registered medical practitioner; “doctor’s list” means a list of doctor’s patients kept by a Health Board– in respect of a doctor providing general medical services, in accordance with regulation 27 of the GMS Regulations , and in respect of a doctor performing personal medical services , in accordance with paragraph 3 of the Directions to Health Boards Concerning Patient Lists (Personal Medical Services) made under section 6(1) of the 1997 Act; “the GMS Regulations” means the National Health Service (General Medical Services) (Scotland) Regulations 1995 ; “medical card” means a card issued to a person for the purpose of enabling him to obtain, or establishing his title to receive primary medical services , other than contraceptive services, maternity medical services, child health surveillance services and minor surgery services; “pilot scheme provider” means a person, other than a Health Board, who is a party to a pilot scheme agreement; “pilot scheme agreement” means an agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme under section 1(1)(a) of the 1997 Act; “pooled list” means a list of persons who have been accepted by a pilot scheme provider for the provision of personal medical services, and whose names are not included in a doctor’s list; “temporary resident” shall be construed in accordance with regulation 7; and b “child health surveillance services”, “contraceptive services”, “maternity medical services” and “minor surgery services” have the meanings respectively assigned to them in the GMS Regulations . Procedure for choosing a doctor 2 1 Any person who wishes to receive primary medical services may choose the doctor from whom he is to receive those services (being a doctor who provides general medical services or who is primarily responsible for the performance of personal medical services under a pilot scheme agreement ), subject to– a the consent of that doctor; and b any limit on the maximum number of persons whose names may be included in that doctor’s list, imposed by regulation 21 of the GMS Regulations or, as the case may be, directions given under section 17F(3) of the 1978 Act . 2 An application for inclusion of a person’s name in a doctor’s list shall be made by delivering to the doctor a medical card or an application signed (in either case) by the applicant or a person authorised by the applicant to sign on his behalf. Change of doctor 3 1 A person whose name is already included in a doctor’s list, but who wishes to change doctor, may, in accordance with regulation 2, apply to another doctor who provides general medical services or performs personal medical services for inclusion of his name in that other doctor’s list. 2 The Health Board shall give notice in writing to all the persons whose names are included in a doctor’s list of any of the following events:– a the death of the doctor; b the fact that the doctor has ceased to provide general medical services under an arrangement with the Health Board, otherwise than to enable him to perform personal medical services in the Health Board’s area; c the fact that the doctor has ceased to perform personal medical services in the Health Board’s area, otherwise than to enable him to provide general medical services under an arrangement with the Health Board. 3 Where in any case in which the Health Board is obliged to give notice under paragraph (2), a successor is appointed to the doctor’s practice under Part III of the GMS Regulations or, as the case may be, a pilot scheme agreement is varied to allow a named doctor to perform personal medical services as a successor to the first-named doctor (and the named doctor will be primarily responsible for the performance of personal medical services under a pilot scheme agreement), a Health Board shall in writing inform each person whose name is included in the list of the doctor who last carried on that practice– a of the name of the successor (and, if more than one, of each of them) and of the address of the practice premises; and b that his name will be deemed to be included in the list of a named successor from a specified date and will be transferred to that list at the end of the period of 14 days beginning on that date unless, before the date on which the transfer is to occur, he gives notice in writing to the Health Board that he does not wish his name to be included in that list. 4 Where no successor is to be appointed to a practice, the Health Board shall notify the persons whose names are included in the list of the doctor who last carried on that practice of their right to apply to another doctor for acceptance. Assignment of persons to doctors 4 1 Where– a a person whose name is not included in the list of any doctor has been refused acceptance by a doctor for inclusion in his list; b a person whose name is included in the list of a doctor, but wishes to change doctor, has been refused acceptance by a doctor for inclusion in his list; or c a person has applied to a doctor under regulation 7(1) to be accepted by him as a temporary resident and that application has been refused, he may apply in writing to the Health Board for assignment to a doctor. 2 On receipt of an application for assignment to a doctor, the Health Board shall– a subject to paragraph (4), assign the applicant to any doctor with whom the Health Board has made arrangements for the provision of general medical services, and notify the doctor and the applicant accordingly; or b require a pilot scheme provider to assign the applicant in accordance with regulation 5 to a doctor who performs personal medical services in connection with a pilot scheme agreement to which the pilot scheme provider is a party. 3 In deciding on the doctor to whom a person should be assigned or, as the case may be, the pilot scheme provider who should be required to make such an assignment, the Health Board shall have regard to– a the respective distances between the person’s residence and the practice premises of the doctors in the part of the Health Board’s area in question; b whether during the period of six months ending on the date on which the application for assignment is received by the Health Board the person’s name has been removed from the list of any doctor in that part of the area at the request of that doctor or, as the case may be, a pilot scheme provider; and c such other matters as the Health Board considers to be relevant. 4 No person may be assigned to a doctor under this regulation without the consent of the Secretary of State if the number of persons whose names are already included in that doctor’s list is equal to or greater than the maximum prescribed in relation to that doctor by regulation 21 of the GMS Regulations. 5 Where– a the Secretary of State refuses his consent for the purposes of paragraph (4); or b a pilot scheme provider is unable to comply, in accordance with regulation 5, with a requirement to assign an applicant to a doctor, and the Health Board is satisfied, after due enquiry, that the person concerned still wishes to be assigned to a doctor it shall as soon as practicable assign, or require the assignment of, that person to another doctor in accordance with the provisions of this regulation. 6 A doctor to whom a person is assigned under this regulation or regulation 5 shall not be required to provide child health surveillance services, contraceptive services, maternity medical services or minor surgery services for that person, unless– a he has accepted him for the provision of such services under the GMS Regulations ; or b he is obliged to provide those services to him in connection with a pilot scheme agreement. 7 Where– a a doctor has requested a Health Board to remove a person’s name from his list under paragraph 9(2) of Schedule 1 to the GMS Regulations; or b a pilot scheme provider has requested the Health Board to remove a person’s name from a doctor’s list or a pooled list under corresponding provisions of a pilot scheme agreement , the Health Board shall take all reasonable steps to assign, or to require the assignment of, the person to another doctor before the end of the working day after the date on which the Health Board receives notification from the doctor or the pilot scheme provider under paragraph 9(2) of Schedule 1 to the GMS Regulations or corresponding provisions of a pilot scheme agreement, or as soon as possible thereafter; and the provisions of this regulation shall apply to such an assignment as if the person had applied for an assignment. 8 The Health Board may exempt from the requirement to have persons assigned to him under this regulation any doctor who provides general medical services and who applies to the Health Board for that purpose. 9 In considering an application under paragraph (8) the Health Board shall have regard to– a the doctor’s age and state of health; b the number of persons whose names are included in his list; and c where the application relates only to a specified person whose name has previously been removed from the list of the doctor, the circumstances of that removal, and the Health Board shall notify any such doctor in writing of any decision under this paragraph. Assignment by a pilot scheme provider 5 1 A pilot scheme provider who is required under regulation 4(2)(b) to assign an applicant to a doctor shall (subject to paragraphs (3), (4) and (5) of this regulation) assign the applicant to a doctor within the period of two days beginning on the day on which he receives notice of the requirement to assign and shall, upon making that assignment, notify– a the Health Board of the name of the doctor to whom the applicant has been assigned; and b the doctor of the assignment, and the Health Board shall, on receipt of notification under sub-paragraph (a), notify the applicant of the doctor to whom he has been assigned. 2 In deciding on the doctor to whom a person should be assigned, the pilot scheme provider shall have regard to– a the respective distances between the person’s residence and the practice premises of the doctors to whom he might assign that person (in this paragraph called “the relevant doctors”); b whether within the period of six months ending on the date on which notice of the requirement to assign is received by the pilot scheme provider the person’s name has been removed from the list of any of the relevant doctors at the request of the pilot scheme provider; and c such other matters as the pilot scheme provider considers to be relevant. 3 No person may be assigned to a doctor under this regulation without the consent of the Secretary of State if the number of persons whose names are already included in that doctor’s list is equal to or greater than any maximum imposed by directions given under section 17F(3) of the 1978 Act. 4 A pilot scheme provider may not assign the applicant to a doctor if that assignment would contravene the terms of a pilot scheme agreement, in particular as to– a whether the doctor is to be primarily responsible for the performance of personal medical services; and b if so, the maximum number of persons who may be included in his doctor’s list. 5 A pilot scheme provider may only seek to assign the applicant to a doctor in a case where the consent of the Secretary of State is required under paragraph (3) if there is no other doctor to whom he could make an assignment in accordance with this regulation which would not require the consent of the Secretary of State. 6 A pilot scheme provider shall inform the Health Board forthwith if– a he has sought the consent of the Secretary of State for the purposes of paragraph (3) and that consent has been refused; or b he is unable to assign the applicant to any doctor without contravening the terms of a pilot scheme agreement, and shall, in each of those cases, provide personal medical services to the applicant (which provision need not include the services mentioned in regulation 4(6), unless the pilot scheme provider is obliged to provide those services to the applicant in connection with a pilot scheme) for the period of 14 days commencing on the day on which the pilot scheme provider so informs the Health Board, or if the applicant is accepted by a doctor or another pilot scheme provider or assigned to a doctor within that period, until he is so accepted or assigned. Representations against assignment or a requirement to assign 6 1 A doctor to whom a person has been assigned by the Health Board may, within the period of seven days beginning on the day on which he receives notice of the assignment, make representations in writing to the Health Board against that assignment, but shall remain responsible for the treatment of the person assigned to him, pending notification of the confirmation or revision of the assignment by the Health Board. 2 A pilot scheme provider who has been required under regulation 4(2)(b) to assign a patient to a doctor may, within the period of seven days beginning with the day on which that assignment is made, make representations in writing to the Health Board against the requirement to assign, but shall remain responsible for providing personal medical services for the person to whom the requirement relates, pending notification of the confirmation or revision of the assignment by the Health Board. 3 Where representations are made to it against an assignment or, as the case may be, a requirement to assign, the Health Board shall, subject to paragraph (4), review the decision to assign or to require assignment at its next meeting and shall either confirm or revise it, but no person who participated in making a decision to assign or to require assignment shall participate in a review of that decision. 4 Where representations are made against a decision to assign or require assignment, the Health Board shall, before meeting to confirm or revise that decision, give the doctor or, as the case may be, the pilot scheme provider, the opportunity to address it in the course of an oral hearing in support of those representations. 5 The Health Board shall, within the period of seven days beginning with the day on which it confirms or revises a decision under paragraph (3), notify the doctor or, as the case may be, the pilot scheme provider, accordingly and the provisions of these Regulations shall apply to any assignment or requirement to assign under a revised decision. Temporary residents 7 1 A person requiring treatment who is– a temporarily residing away from his normal place of residence and is not included in the list of a doctor who practices in the vicinity of the place where he is temporarily residing, or a pooled list of doctors who practise in that vicinity; or b moving from place to place and not for the time being resident in any place, may apply to any doctor who provides general medical services or is primarily responsible for the performance of personal medical services under a pilot scheme agreement in the area in which he is temporarily resident, to be accepted by him as a temporary resident. 2 For the purposes of paragraph (1), a person shall be regarded as temporarily resident in a place if, when he arrives in that place, he intends to stay there for more than 24 hours, but no more than ninety days. Transfer of doctors between provision of general medical services and performance of personal medical services 8 1 Where a person has chosen a doctor from whom he is to receive general medical services and– a his name is included in the list of that doctor; or b he has been accepted for inclusion of his name in such a list, he shall, subject to regulation 3(1) and his right to withdraw from the list of a doctor under regulation 25(1) of the GMS Regulations, continue to be included in the list of his chosen doctor notwithstanding that the doctor ceases to provide general medical services, if the doctor– i immediately starts to perform personal medical services in connection with a pilot scheme agreement and one of the parties to that agreement is a Health Board which previously made arrangements with the doctor for the provision of general medical services; and ii is primarily responsible for the performance of personal medical services under that agreement. 2 Where a person has chosen a doctor from whom he is to receive personal medical services and– a his name is included in the list of that doctor; or b he has been accepted for inclusion of his name in that list, he shall, subject to regulation 3(1) and his right to withdraw from the list of a doctor under paragraph 7 of the Directions to Health Boards Concerning Patient Lists (Personal Medical Services) made under section 6(1) of the 1997 Act, continue to be included in the list of his chosen doctor notwithstanding that the doctor ceases to perform personal medical services, if the doctor immediately starts to provide general medical services by virtue of an arrangement made with him by the Health Board which was a party to the pilot scheme agreement in connection with which he previously performed personal medical services. Sam Galbraith Minister for Health St Andrew’s House, Edinburgh 9th March 1998