GMS Contract PMS Agreement APMS Contract Who can hold the contract? Individual medical practitioner Two or more individuals practising in partnership where: at least one partner is a medical practitioner, and any other partner is either an NHS employee; or an individual eligible under s88 of the NHS Act A company limited by shares The above is a summary only. Please refer to Annex 1 for more detail. Medical practitioner NHS employee Health care professional Individuals already providing services under a GMS, or GDS contract or equivalent (UK) Individuals eligible under s93 of the NHS Act Qualifying body (which is a company limited by shares with restrictions on share ownership) NHS trust or foundation trust The above is a summary only. Please refer to Annex 2 for more detail. The APMS Directions do not state who can hold a contract. Instead it states that particular types of persons cannot hold a contract if they are not eligible. Please refer to Annex 3 for more detail.
(a) a person falling within section 93(1)(b) to (d) of the Act (persons with whom agreements may be made under section 92), to whom paragraph (2) applies; (b) a qualifying body if paragraph (2) applies to— (i) the qualifying body, (ii) any person both legally and beneficially owning a share in the qualifying body, and (iii) any director or secretary of the qualifying body. (2) This paragraph applies if— (a) the contractor is the subject of a national disqualification; (b) subject to paragraph (3), the contractor is disqualified or suspended (other than by interim suspension order or direction pending an investigation) from practising by a licensing body anywhere in the world; (c) the contractor has, within the period of five years before the signing of the agreement or commencement of the agreement (whichever is the earlier) been dismissed (otherwise than by reason of redundancy) from any employment with a health service body, unless— (i) if the contractor was employed as a member of a health care profession at the time of the dismissal, the contractor has not subsequently been employed by that health service body or by another health service body, and (ii) the dismissal was the subject of a finding of unfair dismissal by any competent tribunal or a court; (d) the contractor has, within the period of five years before the signing of the agreement or commencement of the agreement (whichever is the earlier), been removed from, or refused admission to, a primary care list by reason of inefficiency, fraud or unsuitability (within the meaning of section 151(2), (3) and (4) of the Act(a) (disqualification of practitioners)), or a performers list held by the Board by virtue of regulations made under section 91(3) (persons performing primary medical services) of the Act, unless the contractor’s name has subsequently been included in such a list; (e) the contractor has been convicted in the United Kingdom of murder; (f) the contractor has been convicted in the United Kingdom of a
Historically, practices have often applied an unwritten agreement to the retention period of assigned patients. However, there are no formal arrangements in respect of timescales for patient retention in these circumstances. While the significant majority of practices continue to manage assigned patients in the same manner as an ordinarily registered patient, others may commence a formal removal process immediately following assignment. The Commissioner has a responsibility to ensure that all requests to remove a patient at the request of the contractor must be managed in line with the relevant Regulations/Directions. Part A Annex 1 Example Assignment Notification Example Assignment Notification Part A Annex 2 Example patient letter confirming registration Example patient letter confirming registration Part B1: General List Maintenance for Primary Medical Services Scope
SEVERITY Taking into account the controls in place and their adequacy, how severe would the consequences be of such an incident? Apply a score according to the following scale. Level Descriptor Actual or Potential Impact on Individual(s) Actual or Potential Impact on Organisation 5 Catastrophic DEATH National adverse publicity. Investigation. Litigation expected/certain. 4 Major PERMANENT INJURY: e.g., RIDDOR reportable injury/ Ill health retirement/redeployment RIDDOR reportable Long-term sickness. Litigation expected/certain. 3 Moderate SEMI-PERMANENT INJURY/DAMAGE e.g., injury that takes up to one year to resolve or requires Occupational Health involvement/rehabilitation Litigation possible but not certain. High potential for complaint. 2 Minor SHORT-TERM INJURY/DAMAGE eg, injury that has been resolved within one month Short-term sickness. Minimal risk to organisation. Litigation unlikely. Complaint possible. 1 Insignificant NO INJURY OR ADVERSE OUTCOME No risk at all to organisation. Unlikely to cause complaint.
partnership changes; company changes; retirement (including 24-hour retirement); novations, mergers and splits; and/or death of a contractor Joining an MCP or PACS There are specific processes to follow on the death of a contractor. Please refer to the chapter on the death of a contractor for further information. The GMS and PMS Regulations and the APMS Directions contain provisions relating to the remaining scenarios listed above which are considered in more detail below. Partnership Changes Changes to the composition of a partnership will require variation to the contract and may require a variation to the standard registration conditions with the CQC. Procurement law may be relevant as, in some circumstances, the admittance of a new contracting party may give rise to procurement obligations. Commissioners should refer to relevant published guidance and should take appropriate advice at an early stage. Commissioners must also act in accordance with any procurement protocol issued by NHS England. The GMS Regulations, the PMS Regulations and the APMS Directions place restrictions on the organisational structures that are eligible to enter into different types of primary medical contracts. Please refer to the ‘Contracts Described’ chapter for details on the eligibility criteria. Contracts may be varied in a number of ways with relation to partnership matters, including the following which are looked at in more detail below:
carrying out a financial reconciliation; and any other requirements in the contract relating to termination. The Commissinoer will need to agree a new contract with the new contractor which may vary from the original contract in terms of services provided and any other changes agreed. Where the request is for incorporation, the new contractor will be a body corporate and the Commissioner should consider whether it is appropriate to require that the new contract contains a change of control clause. Such a clause requires the contractor to notify the Commissioner where there is a change in ownership or control of the contractor. Legal advice should be sought on the wording of the change of control clause. Where a contract contains such a clause and the Commissioner does not consent to the change but the contractor proceeds anyway, the Commissioner may issue a Remedial Notice. Commencement of the new contract should be made conditional on the new contractor being CQC registered. The CQC cannot provide the Notification of Decision until the date of commencement is agreed. The contractor should, however, provide the Commissioner with written confirmation from the CQC that the CQC does not intend to impose any restrictions on registration of the new contractor. Disputes Where the contractor does not agree with the Commissioner's decision, the contractor may appeal the decision. Please refer to the chapter on managing disputes for further information. Payment system requirements Following the commissioner's decision, any changes to the contracts must be made on the relevant payment and contract management systems. Practice Mergers and/or Contractual Mergers A GP or partnership may hold more than one form of primary care contract with a Commissioner. For example a GMS contractor can also be a party
As set out in the relevant chapter on NHS England's general duties, section 13Q of the NHS Act 2006 requires NHS England to make arrangements to involve the public in the commissioning of services (see the box at the end of this section in relation to CCG duties). The requirements are triggered if there are proposals that mean that patients would experience a change to the range of services available or the manner in which they are delivered (e.g. if a practice is closed following a practice merger). As set out in the chapter on NHS England's general duties, NHS England has published guidance on section 13Q in the form of "The Statement of Arrangements & Guidance on Patient and Public Participation in Commissioning" (the "Statement"). The Statement sets out that a change in the GP delivering the service is not usually enough to trigger the duty but that care must be taken if a change in personnel makes services less accessible to patient groups (e.g. because patients wish to be treated by someone of the same religion and gender as them). Where a practice merger may result in a change of the personnel delivering the service, the Commissioner should be alert to this. In practice, what will be sufficient in terms of patient involvement is very context specific. The extent of the patient engagement activities required will depend on a number of factors including the extent of the impact any changes will have. As a general rule, the greater the extent of changes and number of people affected, the greater the level of activity that is likely to be necessary to achieve an appropriate level of public involvement. Generally speaking, to meet the section 13Q duty, involvement needs to apply to and inform the whole decision making process, but this does not mean that patients need to be actively involved at every moment. Provided involvement is suitably built into the overall process, its timing can be arranged at stages to suit the Commissioner's decision-making processes. In particular, it is not necessary to involve patients immediately at the outset of any planning/consideration/decision making process in relation to any proposals of the commissioning of new services, provided patient involvement is planned for some early stage in the process. The plans for patient involvement should be clearly documented from the outset and the Commissioner should consider
certain partnership matters; for PMS agreements: carrying on business detrimental to the agreement, the notice must specify a date on which the contract terminates that is not less than 28 days after the date on which the Commissioner has served the notice on the contractor. The Commissioner may state a date less than 28 days where this is necessary to protect the safety of the contractor's patients or protect NHS England from material financial loss. APMS contracts are not required to contain any such provisions and the Commissioner should consider the wording of the particular APMS contract. Where the contractor disputes the Commissioner's decision to terminate the contract, the contractor may invoke the NHS dispute resolution procedure. In such circumstances, the Commissioner should refer to the chapter on managing disputes. Where a Termination Notice is issued, the Commissioner should submit a Notice Return to the NHS England primary care inbox () as soon as practicable after issue. A template Notice Return is set out Annex 13 (see also 1.4). Key Considerations on Termination The Commissioner must establish that grounds exist under the terms of the contract to terminate. The Commissioner must follow due process and investigation of the facts and provide the contactor with the opportunity to provide a response to allegations, wherever possible. A flowchart highlighting the main steps that the Commissioner should take when issuing a termination notice is set out in Annex 10. The Commissioner must consider all relevant information available and decide on the appropriate course of action and whether the contract should be terminated. Apart from considerations regarding whether the right to terminate arises, there are a number of common factors that the Commissioner should consider when termination is a proposed course of action. These factors are set out below. This list is not exhaustive and there are likely to be other issues that need due consideration under these provisions. These considerations will also apply following
Period of cover: …………………………….…………. (No. of weeks: ……………) Number of clinical sessions worked……….. Amount paid to individual: £………………………….. Name and surname: …………………………………………………………………… Period of cover: …………………………….…………. (No. of weeks: ……………) Number of clinical sessions worked………… Amount paid to individual: £………………………….. Name and surname: ……………………………………………………………………. Period of cover: …………………………….…………. (No. of weeks: …………….) Number of clinical sessions worked………… Amount paid to individual: £………………………….. Details of internal GPs covering absence If employing an external locum GP to cover the GP performer’s absence, then please complete the information below (add more lines if required). Name and surname: …………………………………………………………………… Period of cover: …………………………….…………. (No. of weeks: ……………) Number of clinical sessions worked………..