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STATUTORY INSTRUMENTS

2001 No. 3740
NATIONAL HEALTH SERVICE, ENGLAND
The National Health Service (General Medical Services Supplementary List) Regulations 2001

	Made	22nd November 2001
	Laid before Parliament	22nd November 2001
	Coming into force	14th December 2001

The Secretary of State, in exercise of the powers conferred upon him by sections 29, 43D and 126(4) of the National Health Service Act 1977[1] and section 65 of the Health and Social Care Act 2001[2], and all other powers enabling him in that behalf, hereby makes the following Regulations:

Citation, commencement and application
     1. - (1) These Regulations may be cited as the National Health Service (General Medical Services Supplementary List) Regulations 2001 and shall come into force on 14th December 2001.

    (2) These Regulations extend to England only.

Interpretation
     2. - (1) In these Regulations, unless the context otherwise requires -

"Abolition of the Tribunal Regulations" means the Abolition of the National Health Service Tribunal (Consequential Provisions) Regulations 2001[

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"contingent removal" shall be construed in accordance with section 49G;

"doctor" means a registered medical practitioner;

"director" means -

"employment" means any employment whether paid or unpaid and whether under a contract for services or a contract of service, and "employed" and "employer" shall be construed accordingly;

"equivalent body" means a Health Authority in Wales, a Health Board or an NHS trust in Scotland or a Health and Social Services Board in Northern Ireland;

"equivalent lists" means lists kept by an equivalent body;

"FHSAA" means the Family Health Services Appeal Authority constituted under section 49S;

"fraud case" means a case where a person satisfies the second condition for removal from the medical list, set out in section 49F(3) or by virtue of section 49H is treated as doing so;

"General Practice (GP) Registrar" means a doctor who is being trained in general practice by a doctor whose name is included in a medical list;

"Health Committee" means the Health Committee of the General Medical Council constituted under section 1(3) of the Medical Act 1983;

"licensing or regulatory body" means the body that licenses or regulates any profession of which the doctor is, or has been a member, and includes a GP educational competent body;

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"a national disqualification" means -

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"originating events" means the events that gave rise to the conviction, investigation, proceedings, suspension, refusal to admit, conditional inclusion, removal or contingent removal that took place;

"Preliminary Proceedings Committee" means the Preliminary Proceedings Committee of the General Medical Council constituted under section 1(3) of the Medical Act;

"professional conduct" includes matters relating both to professional conduct and professional performance;

"Professional Conduct Committee" means the Professional Conduct Committee of the General Medical Council constituted under section 1(3) of the Medical Act;

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"services list" means a list prepared under section 28DA of the National Health Service Act 1977 or under section 8ZA of the Primary Care Act;

"suspended" means -

and shall be treated as including a case where a person is treated as suspended by a Health Authority in England by virtue of regulation 6(2) of the Abolition of the Tribunal Regulations,

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(2) All references in these Regulations to sections are to sections of the National Health Service Act 1977 except where specified otherwise.

(3) Unless the context requires otherwise -

(b) any reference in a regulation or in a schedule to these Regulations to a numbered paragraph is a reference to the paragraph bearing that number in that regulation or schedule.

Supplementary list
3. - (1) A Health Authority shall prepare and publish a supplementary list of all doctors approved by the Health Authority for the purposes of assisting in the provision of general medical services.

(2) In respect of any doctor whose name is included in it, the list shall include -

(a) the doctor's full name;

(b) professional registration number;

(c) his date of birth, where he consents, or if not, his date of first registration in the Medical Register; and

(d) the date that the doctor's name was included in the list.

    (3) The list shall be available for public inspection.

Application for inclusion in the supplementary list
     4. - (1) An application by a doctor for the inclusion of his name on the supplementary list shall be made by sending the Health Authority an application in writing, which shall include the information mentioned in paragraph (2).

    (2) The doctor shall provide the following information -

(a) full name;

(b) sex;

(c) date of birth;

(d) private address and telephone number;

(e) medical qualifications and where obtained, a copy of evidence concerning the applicant's qualifications and experience produced in accordance with the National Health Service (Vocational Training for General Medical Practice) Regulations 1997[

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(i) names and addresses of two referees who are willing to provide clinical references relating to two recent posts (which may include any current post) as a doctor which lasted at least three months without a significant break, and where this is not possible, a full explanation and alternative referees;

(j) details of any Health Authority list or equivalent lists from which he has been removed, conditionally removed, or to which he has been refused admission or conditionally included, or from which he is currently suspended, with an explanation as to why, or particulars of any outstanding application (including deferred applications);

(k) if the applicant is the director of any body corporate that is included in any list of any Health Authority, or equivalent lists, or which has an outstanding application (including a deferred application) for inclusion in any list of any Health Authority or equivalent list, the name and registered office of any such body, and details of the Health Authority or equivalent body concerned;

(l) where he is, or was in the preceding six months, or was to his knowledge at the time of the originating events a director of a body corporate, details of any Health Authority list or equivalent lists for which that body has been refused admission, conditionally included, removed, contingently removed or from which it is currently suspended, with an explanation as to why;

(m) any other information that the Health Authority may reasonably require to determine the doctor's application.

(3) The doctor shall provide the following undertakings and consents -

(4) The doctor shall send with the application a declaration as to whether he -

and if so, give details, including approximate dates, of where any investigation or proceedings were or are to be brought, the nature of that investigation or proceedings, and any outcome.

(5) If the doctor is, has in the preceding six months been, or was to his knowledge at the time of the originating events a director of a body corporate, he shall in addition make a declaration to the Health Authority as to whether the body corporate -

and if so, give the name and registered office of the body corporate and details, including approximate dates, of where any investigation or proceedings were or are to be brought, the nature of that investigation or proceedings, and any outcome.

    (6) The doctor shall consent to a request being made by the Health Authority to any employer or former employer, licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, by them into the doctor or a body corporate referred to in sub-paragraphs (2), (4) and (5).

Readmission
     5. Where a doctor has been removed from a medical, supplementary or services list by a Health Authority on the grounds that he had been convicted of a criminal offence, and that conviction is overturned on appeal, that Health Authority may agree to include the doctor in its supplementary list without a full application if it is satisfied that there are no other matters that need to be considered and provided that it receives an undertaking to comply with the requirements of these regulations.

Grounds for refusal
     6. - (1) The grounds on which a Health Authority may refuse to include a doctor in its supplementary list are -

(a) that the Health Authority having considered the declaration required by regulation 4(4) and (5) and any other information in their possession in relation to this application, consider he is unsuitable to be included in the list;

(b) that having checked the information provided by the doctor under regulation 4(2)(e) and (f) the Health Authority consider the practitioner is unsuitable to be included in the list;

(c) that having contacted referees provided by the doctor under regulation 4(2)(i), the Health Authority are not satisfied with the references;

(d) that having checked with the National Health Service Counter Fraud Service for any facts that they consider relevant relating to past or current fraud investigations involving the doctor, and having considered these and any fraud case relating to the doctor, the Health Authority consider these justify such refusal;

(e) that there are any grounds for considering that admitting the practitioner to the list would be prejudicial to the efficiency of the service which he would undertake;

(f) where his registration in the register of medical practitioners is subject to conditions imposed pursuant -

(i) to a direction of the Professional Conduct Committee under section 36 of the Medical Act,

(ii) to a direction of the Health Committee under section 37 of that Act,

(iii) to an order of either of those committees or the Preliminary Proceedings Committee under section 42 of that Act,

(iv) to a direction of the Committee on Professional Performance under section 36A of that Act[

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(2) The grounds on which a Health Authority must refuse to include a doctor in its supplementary list are -

(3) Before making a decision on the application, the Health Authority shall -

(4) Where the Health Authority is considering refusal of a doctor under paragraph (1) or (2) it shall consider all facts which appear to it to be relevant, and shall in particular take into consideration in relation to paragraph (1)(a), (d) or (e) above -

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    (5) When the Health Authority takes into consideration the matters set out in paragraph (4), they shall consider the overall effect of all the matters being considered.

    (6) When refusing to include a doctor in its list, the Health Authority shall notify the doctor of its decision and the reasons for it (including any facts relied upon), and of any right of appeal under regulation 15 against the Health Authority's decision.

Deferment of decision on application
     7. - (1) A Health Authority may defer a decision on an application to be included in the supplementary list received after 28th February 2002 -

(a) where there are legal proceedings that are criminal proceedings in the United Kingdom or, if brought elsewhere in the world, would be criminal proceedings if brought in the United Kingdom, and that if successful would be likely to lead to the removal of the doctor from the Health Authority list if he had been included;

(b) where there are legal proceedings against a body corporate of which the doctor is, has in the preceding six months been, or was at the time of the originating events a director, that are criminal proceedings in the United Kingdom or if brought anywhere else in the world would be criminal proceedings if brought in the United Kingdom, and that if successful would be likely to lead to the removal of the doctor from the Health Authority list if he had been included;

(c) where there is an investigation anywhere in the world by the doctor's licensing or regulatory body or any other investigation (including one by another Health Authority or equivalent body) relating to him in his professional capacity that if successful would be likely to lead to the removal of the doctor from the Health Authority list if he had been included;

(d) where the doctor is suspended from any of the lists or equivalent lists;

(e) where a body corporate of which the doctor is, has in the preceding six months been, or was at the time of the originating events a director, is suspended from any of the lists or equivalent lists;

(f) where the FHSAA is considering an appeal by the doctor against a decision of a Health Authority to refuse to approve, nominate or admit a doctor to its list, or to conditionally include in or to contingently remove from, or to remove from any list kept by a Health Authority and if that appeal is unsuccessful the Health Authority would be likely to remove the doctor from the Health Authority list if he had been included;

(g) where the FHSAA is considering an appeal by a body corporate of which the doctor is, has in the preceding six months been, or was at the time of the originating events a director, against a decision of a Health Authority to refuse to approve, nominate or admit a doctor to its list, or to conditionally include in or to contingently remove from, or to remove from any list kept by a Health Authority and if that appeal is unsuccessful the Health Authority would be likely to remove the doctor from the Health Authority list if he had been included;

(h) where the doctor is being investigated by the National Health Service Counter Fraud Service in relation to any fraud, where the result if adverse would be likely to lead to the removal of the doctor from the Health Authority list if he had been included;

(i) where a body corporate, of which the doctor is, has in the preceding six months been, or was at the time of the originating events a director, is being investigated by the National Health Service Counter Fraud Service in relation to any fraud, where the result if adverse would be likely to lead to the removal of the doctor from the Health Authority list if he were to be included;

(j) where the FHSAA is considering an application from a Health Authority for a national disqualification of the doctor;

(k) where the FHSAA is considering an application from a Health Authority for a national disqualification of the doctor or a body corporate of which the doctor is, has in the preceding six months been, or was at the time of the original events a director.

    (2) A Health Authority may only defer a decision under paragraph (1) above until the outcome of the relevant event mentioned in sub-paragraphs (a) to (k) is known.

    (3) The Health Authority must notify the applicant that it has deferred a decision on the application and the reasons for it.

    (4) Once the outcome of the relevant event mentioned in paragraph (1) is known, the Health Authority must notify the practitioner that he must update his application within 28 days (or such longer period as the Health Authority may agree) with any relevant information before it can be considered.

    (5) Provided any additional information has been received within the 28 days or the time agreed, the Health Authority shall notify the applicant as soon as possible -

(a) that his application to be included has been successful; or

(b) that the Health Authority has decided to refuse the application or impose conditions on his inclusion, and the reasons for it (including any facts relied upon), and any right of appeal under regulation 15.

Conditional Inclusion
     8. - (1) A Health Authority may determine that if a person is to be included in the supplementary list, he is to be subject, while he remains included in the list, to the imposition of conditions, having regard to the requirements of section 43D(5).

    (2) Failure to comply with a condition may lead to the removal of the doctor from the list.

    (3) Where the Health Authority is considering the removal of a doctor for breach of a condition, it shall -

(a) give the doctor notice of any allegation against him;

(b) give him notice of the grounds for the action it is considering;

(c) give him the opportunity to make written representations to the Health Authority within 28 calendar days of the date of the notification under sub-paragraph (b);

(d) give him the opportunity to put his case at an oral hearing before the Health Authority, if he requests one within the 28 day period mentioned in sub-paragraph (c).

(a) is convicted of any criminal offence in the United Kingdom;

(b) is bound over following a criminal conviction in the United Kingdom;

(c) accepts a police caution in the United Kingdom;

(d) is convicted elsewhere of an offence, or what would constitute a criminal offence if committed in England and Wales, or is subject to a penalty which would be the equivalent of being bound over or cautioned;

(e) is charged in the United Kingdom with a criminal offence, or is charged elsewhere with an offence which, if committed in England and Wales, would constitute a criminal offence;

(f) is notified by any licensing, regulatory or other body anywhere in the world, of the outcome of any investigation into his professional conduct, and there is a finding against him;

(g) becomes the subject of any investigation into his professional conduct by any licensing, regulatory or other body;

(h) becomes subject to an investigation into his professional conduct in respect of any current or previous employment, or is notified of the outcome of any such investigation if adverse;

(i) becomes to his knowledge the subject of any investigation by the National Health Service Counter Fraud Service in relation to fraud;

(j) becomes the subject of any investigation by another Health Authority or equivalent body, which might lead to his removal from any of that Health Authority's lists or equivalent lists;

(k) is removed, contingently removed, suspended, refused admission to, or conditionally included in any list or equivalent list kept by another Health Authority or equivalent body,

and if so, give details, including approximate dates, of where any investigation or proceedings were or are to be brought, the nature of that investigation or proceedings, and any outcome.

(2) If the doctor is, or was in the preceding six months, or was to his knowledge at the time of the originating events a director of a body corporate, he shall make a declaration to the Health Authority in writing within 7 days of its occurrence if that body corporate -

(a) is convicted of any criminal offence in the United Kingdom;

(b) is convicted elsewhere of an offence, or what would constitute a criminal offence if committed in England and Wales, or is subject to a penalty which would be the equivalent of being bound over or cautioned;

(c) is charged in the United Kingdom with a criminal offence, or is charged elsewhere with an offence which, if committed in England and Wales, would constitute a criminal offence;

(d) is notified by any licensing, regulatory or other body anywhere in the world, of the outcome of any investigation into its provision of professional services, and there is a finding against the body corporate;

(e) becomes the subject of any investigation into its provision of professional services by any licensing, regulatory or other body anywhere in the world;

(f) becomes to his knowledge the subject of any investigation by the National Health Service Counter Fraud Service in relation to a fraud case, or is notified of the outcome of such an investigation if adverse;

(g) becomes the subject of any investigation by another Health Authority or equivalent body, which might lead to its removal from any of that Health Authority's lists or equivalent lists;

(h) is removed, contingently removed, suspended, refused admission to, or conditionally included in any list or equivalent list kept by another Health Authority or equivalent body,

and if so, give the name and registered address of the body corporate and details, including approximate dates, of where any investigation or proceedings were or are to be brought, the nature of that investigation or proceedings, and any outcome.

(3) The doctor shall consent to a request being made by the Health Authority to any employer or former employer, licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, by them into the doctor or a body corporate referred to in sub-paragraph (1) and (2).

Removal from supplementary list
10. - (1) The Health Authority must remove the doctor where it becomes aware that -

(a) the doctor has been convicted in the United Kingdom of murder;

(b) the doctor has been convicted in the United Kingdom since the date on which these Regulations came into force of a criminal offence and has been sentenced to a term of imprisonment of over six months;

(c) the doctor has been nationally disqualified;

(d) the doctor has died;

(e) he is no longer a doctor;

(f) he is the subject of -

(g) where he is included in the medical or services list of any Health Authority, or the supplementary list of another Health Authority,

and shall notify the doctor immediately that it has done so.

(2) Where a Health Authority is notified by the FHSAA that it has considered -

(a) an appeal by a doctor against a contingent removal by the Health Authority and has decided to remove him instead; or

(b) an appeal by a doctor against a conditional inclusion, where the doctor has been conditionally included in the list until the appeal has been decided, and has decided not to include him,

the Health Authority shall remove the doctor and shall notify the doctor immediately that it has done so.

(3) The Health Authority may remove a doctor from the supplementary list where any of the conditions set out below is satisfied.

(4) The conditions mentioned in paragraph (3) are -

(a) that the continued inclusion of the person concerned in the list would be prejudicial to the efficiency of the services which those included in the list assist in providing ("an efficiency case");

(b) that the person concerned (whether on his own or together with another) is involved in a fraud case in relation to any health scheme; or

(c) that the person concerned is unsuitable to be included in the list ("an unsuitability case").

(5) In addition to the services covered by the definition of "health scheme" in section 49F(8), the following shall also be health schemes -

(a) health services, including medical and surgical treatment, provided by Her Majesty's Forces;

(b) services provided by Port Health Authorities constituted under the Public Health (Control of Disease) Act 1984[

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(6) A Health Authority may also remove a doctor if -

(7) Where the doctor cannot demonstrate that he has assisted in the provision of general medical services within the area of the Health Authority during the preceding twelve months, the Health Authority may remove him from the supplementary list.

(8) In calculating the period of twelve months referred to in paragraph (7), the Health Authority shall disregard any period -

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(9) Where a Health Authority is considering removing a doctor under paragraphs (3) to (7) of this regulation, or contingently removing a doctor under regulation 12, it shall -

    (10) Where the Health Authority decides to remove a doctor under paragraph (7), the doctor shall not be removed from the list for a period of three months starting on the date on which the Health Authority reaches its decision or for a period of three months starting on the date any appeal is disposed of by the FHSAA whichever is the latest.

    (11) If there are no representations within the period specified in paragraph (9)(c), the Health Authority shall inform the doctor of its decision, the reasons for it (including any facts relied upon), and of any right of appeal under regulation 15.

    (12) If there are representations, the Health Authority must take them into account before reaching its decision, and notifying the doctor of its decision, the reasons for it (including any facts relied upon), and of any right of appeal under regulation 15.

    (13) If the doctor requests an oral hearing, this must take place before the Health Authority reaches its decision, and the Health Authority must then notify the doctor of its decision, the reasons for it (including any facts relied upon), and of any right of appeal under regulation 15.

    (14) When the Health Authority notifies the doctor of any decision, it shall inform him that if he wishes to exercise a right of appeal, he has 28 days from the date of the decision to do so, and shall tell him how to do so.

    (15) The Health Authority shall also notify the doctor of his right to have the decision reviewed in accordance with regulation 14.

Criteria for removal
     11. - (1) Where a Health Authority is considering whether to remove a doctor using the power in regulation 10(4)(c) (an unsuitability case), it shall consider the information from the doctor in the form of a declaration supplied under regulation 9, and must apply the criteria set out in paragraph (2).

    (2) The criteria referred to in paragraph (1) are -

(a) the nature of any offence, investigation or incident;

(b) the length of time since any such offence was committed, and since any criminal conviction or investigation;

(c) whether there are other criminal offences to be considered;

(d) the penalty imposed on any criminal conviction or the outcome of any investigation;

(e) the relevance of any criminal offence or investigation into professional conduct on the provision by him of general medical services and the likely risk to patients;

(f) whether any criminal offence was a sexual offence to which Part I of the Sexual Offences Act 1997[

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(3) Where a Health Authority is considering removal of a doctor under regulation 10(4)(b), a fraud case, it shall consider the information from the practitioner in the form of a declaration supplied under regulation 9, and must apply the criteria set out in paragraph (4).

(4) The criteria referred to in paragraph (3) are -

(5) Where a Health Authority is considering removal of a doctor under regulation 10(4)(a), an efficiency case, it shall consider the information from the practitioner in the form of a declaration supplied under regulation 9, and must apply the criteria set out in paragraph (6).

(6) The criteria referred to in paragraph (5) are -

    (7) In making any decision under regulation 10, the Health Authority shall take into account the overall effect of any relevant incidents and offences relating to the doctor of which it is aware, whichever condition it relies on.

    (8) When making a decision on any condition in regulation 10, the Health Authority shall state in its decision on which condition it relies.

Contingent removal
     12. - (1) In an efficiency case or a fraud case the Health Authority may, instead of deciding to remove a doctor from its list, decide to remove him contingently.

    (2) If it so decides, it must impose such conditions as it may decide on his inclusion in the list with a view to -

(a) removing any prejudice to the efficiency of the services in question (in an efficiency case); or

(b) preventing further acts or omissions in a fraud case.

(3) If the Health Authority determine the doctor has failed to comply with a condition, it may decide to -

(a) vary the conditions imposed;

(b) impose new conditions; or

(c) remove him from the list.

Suspension
13. - (1) If a Health Authority is satisfied that it is necessary to do so for the protection of members of the public or is otherwise in the public interest, it may suspend a doctor from its list -

(a) while it decides whether or not to exercise its powers to remove under regulation 10 or contingently remove under regulation 12 (other than in circumstances falling within paragraph (b));

(b) while it waits for a decision affecting the doctor of a court, licensing or regulatory body anywhere in the world;

(c) where it has decided to remove the doctor but before that decision takes effect; or

(d) pending appeal.

    (2) In a case falling within paragraph (1)(a), the Health Authority must specify a period not exceeding six months as the period of suspension.

    (3) In a case falling within paragraph (1)(b), the Health Authority may specify that the doctor remains suspended after the decision referred to there for an additional period not exceeding six months.

    (4) The period of suspension may extend beyond six months if -

(a) on the application of the Health Authority, the FHSAA so orders, and

(b) if the Health Authority have applied under paragraph (a) before the expiry of the period of suspension, but the FHSAA has not made an order by the time it expires, in which case it continues until the FHSAA makes an order.

(5) If the FHSAA does so order, it shall specify -

(a) the date on which the period of suspension is to end;

(b) an event beyond which it is not to continue; or

(c) a combination of (a) and (b).

    (6) The FHSAA may, on the application of the Health Authority, make a further order (complying with paragraph (5)) at any time while the period of suspension pursuant to the earlier order is still continuing.

    (7) If the Health Authority suspends a doctor in a case falling within paragraph (1)(c) or (d), the suspension has effect from the date the Health Authority gave him notice of the suspension until the expiry of any appeal period or, if the practitioner appeals under regulation 15 until the FHSAA has disposed of the appeal.

    (8) The Health Authority may extend the period of suspension under paragraph (1)(a) or impose a further period of suspension under paragraph (3) so long as the aggregate does not exceed six months.

    (9) The effect of a suspension is that while a doctor is suspended under these Regulations he is to be treated as not being included in the list even though his name appears in it.

    (10) The Health Authority may at any time revoke the suspension, and inform the doctor of its decision.

    (11) Where a Health Authority is considering suspending a doctor or varying the period of suspension under this regulation, it shall -

(a) give the doctor notice in writing of any allegation against him;

(b) give the doctor notice of what action the Health Authority is considering and on what grounds;

(c) give him the opportunity to put his case at an oral hearing before the Health Authority on a specified day, provided that at least 24 hours notice of the hearing is given.

    (12) If the doctor does not wish to have an oral hearing or does not attend the oral hearing, the Health Authority shall inform him of its decision and the reasons for it (including any facts relied upon).

    (13) If an oral hearing does take place, the Health Authority shall take into account any representations made before it reaches its decision.

    (14) The Health Authority may suspend the doctor with immediate effect following the hearing.

    (15) The Health Authority shall notify the doctor of its decision and the reasons for it (including any facts relied upon).

    (16) The Health Authority shall inform the doctor of any right of review under regulation 14.

    (17) During a period of suspension, the doctor may be paid by the Health Authority in accordance with a determination by the Secretary of State or a person appointed for the purpose by the Secretary of State.

Reviews
     14. - (1) A Health Authority may, and if requested in writing to do so by the doctor must, review a Health Authority decision to -