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24.- (1) This regulation applies as to the aggregate maximum number (" the maximum number ") of persons a doctor may have on his list in all localities in which he provides general medical services in addition to -
(a) any persons for whom under paragraphs 18 or 18A of the terms of service he has accepted responsibility during certain periods only; and
(b) any persons whom he has accepted for the provision of contraceptive services only.
(2) Except as otherwise provided in this regulation, the maximum number shall be -
(a) 3,500, for a doctor carrying on practice otherwise than as an assistant or in a partnership;
(b) 4,500 for a doctor carrying on practice in partnership, subject to a maximum average of 3,500 for each of the partners in the practice,
and, where the doctor employs an assistant, such further number not exceeding 2,000 for each assistant as the FHSA, or, on appeal, the Secretary of State, may decide in the light of the circumstances of the practice and the amount of time given to it by any assistant.
(3) For the purposes of determining the maximum number of persons on the list, the number of persons on the list of an assistant who is a doctor with a list of his own, shall be regarded as being on the list of the doctor by whom he is employed.
(4) For the purposes of paragraph (2), a doctor who is in partnership shall be deemed to be an assistant, and not a partner, unless the FHSA or, on appeal, the Secretary of State is satisfied that -
(a) he discharges the duties and exercises the powers of a partner in connection with the practice of the partnership; and,
(b) either-
(i) in the case of a full-time doctor, he is entitled to a share of the profits which is not less than one third of the share of the partner with the greatest share, or
(ii) in the case of a three-quarter-time doctor, he is entitled to a share of the profits which is not less than one quarter of the share of the partner with the greatest share, or
(iii) in the case of a half time doctor, he is entitled to a share of the profits which is not less than one fifth of the share of the partner with the greatest share, or
(iv) in the case of a job-sharing doctor who practises in partnership with another job-sharing doctor and at least one further doctor, he is entitled to a share of the profits which, when added to the share of the other job-sharing doctor with whose hours his hours are being aggregated for the purposes of regulation 15(1)(d), is not less than one third of the share of the member of the partnership with the greatest share.
(5) The FHSA shall notify each doctor of the number of patients on his list as at the first day of each period of three months ending 31st March, 30th June, 30th September and 31st December and of the number of any excess over the maximum number.
(6) Subject to paragraphs (10) to (12), if there is an excess, the doctor shall, within two months from the date on which the excess was notified to him, take steps to reduce his list to the maximum number by -
(a) taking a partner;
(b) engaging an assistant; or
(c) notifying the FHSA of the names of the necessary number of patients on his list whom he wishes to have removed from his list under paragraph 9 or 10 of the terms of service,
and if at the end of that time such measures have not been completely effective, the FHSA shall remove from his list the necessary number of patients, the selection of such patients being at the discretion of the FHSA.
(7) Where -
(a) a doctor gives notice under paragraph (6)(c); or
(b) a doctor whose name is included in the medical list in respect of more than one address and who ceases to practise at one of them, informs the FHSA of his wish to have removed from his list the persons who would have attended for treatment at the address at which he will no longer practise,
the FHSA shall, subject to paragraph (8), send a notice to each person so named to inform him that he should apply to another doctor for acceptance.
(8) Where the FHSA, after consulting the Local Medical Committee, accepts an application from the doctor for the notices under paragraph (7) to name another doctor who -
(a) is willing to accept the person on his list; and
(b) has given his written consent in circumstances where such acceptance will not result in an excess number of patients on that other doctor's list (or if that other doctor is in partnership, on the average of the partnership lists),
the notices shall be issued accordingly and the name of any such person shall be included on the list of the doctor named in the notice until such time as the person has chosen another doctor or has informed the FHSA in writing that he wishes not to be so included.
(9) Where an excess number of patients is due to -
(a) the creation of a partnership of which the doctor is a member; or
(b) the death or retirement of a partner or the cessation of employment of an assistant in circumstances where the doctor is actively seeking a new partner or assistant,
the FHSA may, on the doctor's undertaking not to accept further patients other than the children of existing patients, permit him to retain, for such period not exceeding nine months as it may determine from the date of the event which gave rise to the excess number, all the patients on his list (and in a case within sub-paragraph (b) above, on the list, if any, of his former partner or assistant) at that date.
(10) In carrying out its function under this regulation the FHSA shall consult as necessary with any other FHSA whose medical list includes a doctor concerned.
(11) Nothing in this regulation shall-
(a) restrict a doctor from accepting persons who apply to him as temporary residents; or
(b) exempt him from any liability under the terms of service to give treatment immediately required to any person who applies for acceptance or to give emergency treatment.
(12) An appeal under paragraph (2) or (4) shall be made by sending to the Secretary of State a notice of appeal within 30 days of the date on which notice of the decision of the FHSA was given and the notice of appeal shall contain a concise statement of the grounds of appeal.
(13) The Secretary of State shall, on receipt of any notice of appeal under this regulation, send a copy of that notice to the FHSA.
(14) The FHSA may, within 30 days from the date on which the Secretary of State sent a copy of the notice of appeal, submit representations in writing to him on the appeal.
(15) On any appeal pursuant to paragraph (2) or (4), the Secretary of State may, if he thinks fit, hold an oral hearing and in such a case shall -
(a) appoint one or more persons to hear the appeal who shall report to him on the appeal; and
(b) not less than 14 days before the date fixed for the hearing, give notice in writing to the appellant and to the FHSA.
(16) The Secretary of State shall, upon determination by him of an appeal under this regulation, give notice of his decision in writing, together with the reasons for it, to the appellant and to the FHSA.
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| Book Title: NHS GMS Regulations | ||