KEY POINT GENERAL COMPARISON: PMS AGREEMENT AND GMS CONTRACT

Transcription

1 KEY POINT GENERAL COMPARISON: PMS AGREEMENT AND GMS CONTRACT This dcument prvides a general verview f the similarities and differences that exist between a cntractrs bligatins and requirements in respect f a select few items depending n whether they hld a GMS Cntract r PMS Agreement. The dcument cmpares GMS Regulatins and the PMS Regulatins and the mdel GMS Cntract and PMS Agreement (as defined belw). Cntractrs shuld be aware that lcal variatins t their specific PMS Agreement may apply which are nt cvered in this nte. This dcument is fr use as a general guide nly and des nt represent an authritative resurce n the subject matter. As a cnsequence the BMA accepts n liability fr its use. Anyne lking t rely n this nte must take their wn independent legal advice t verify its cntent. In this dcument GMS Cntract: means the NHS England Standard General Medical Services Cntract 2015/16 Available: GMS Regulatins/ GMS Regs: means the Natinal Health Services (General Medical Services Cntracts) Regulatins 2015 Available: PMS Agreement: means the NHS England Standard Persnal Medical Services Agreement 2015/16 Available: PMS Regulatins/ PMS Regs: means the Natinal Health Service (Persnal Medical Services Agreements) Regulatins 2015 Available: Pint Definitins used GMS PMS Cre differences Cre services Essential Services: are brken dwn t cver:- Psitin under the GMS Cntract Regs Psitin under the PMS Regs & PMS Nne. Agreement (i) Services required fr the management f the cntractr s patients wh are, r believe themselves t be:- a. Ill with cnditins frm which recvery is generally expected; b. Terminally ill; r c. Suffering frm chrnic disease The cntractr must prvide essential services thrughut the cre hurs. Psitin under the GMS cntract This blsters the requirement laid ut in the GMS Regs by requiring the cntractr t:- Prvide essential services; Where the PMS Agreement prvides fr the same the cntractr must: prvide thse essential services (and such thers services as the cntractr is required t prvide t its patients)

2 (ii) (iii) Apprpriate nging treatment and care t all registered patients and temprary residents taking accunt f their specific needs (this includes prviding primary medical services require din cre hurs fr the immediately necessary treatment f persns t whm the cntractr has been required t prvide treatment wing t an accident r emergency at any place in its practice area) Services required in cre hurs fr the immediately necessary treatment f any f the fllwing persns wh request such treatment:- at such times within cre hurs As are apprpriate t meet the reasnable needs f its patients; T have in place arrangements fr the cntractr s patients t access such services thrughut the cre hurs in case if emergency. at such times, within cre hurs as are apprpriate t meet the reasnable needs f patients have in place arrangements fr the cntractr s patients t access such services thrughut the cre hurs in case if emergency. a. fr a perid f either i. 14 days fllwing the relevant persns applicatin was refused; r ii. The date upn which the persn has been registered elsewhere fr the prvisin f essential services Persns whse applicatin t be included n the cntractrs list are refused b. fr a perid f either i. 14 days fllwing the relevant persns applicatin as temprary resident was refused; r

3 ii. The date upn which the persn has been registered as a temprary resident elsewhere fr the prvisin f essential services. Persns whse applicatin t be included n the cntractrs list as a temprary resident are refused. c. Fr a perid f 24 hurs r such shrter perid as the persn is present in the cntractr s area, any persn wh is in the cntractr s practice area fr less than 24 hurs. Reg 17 GMS Regs Cl 8.1 GMS Cntract Sch 2 Pt 1 1 PMS Regs & Cl 7.2 PMS Agreement (which refers back t the definitin f Essential Services) Cre Hurs: means the perid beginning at 8 00am and ending at 6 30pm n any day frm Mnday t Friday except Gd Friday, Christmas Day r bank hlidays Patients: defined under the PMS & GMS Regs as- (i) a registered patient; (ii) a temprary resident; (iii) persns t whm the cntractr is required t prvide immediately necessary treatment as part f its bligatin t prvide essential services; and

4 (iv) (v) any ther persn t whm the cntractr has agreed t prvide services under the agreement; and any persn in respect f whm the cntractr is respnsible fr the prvisin f ut f hurs services. Temprary residents: generally cvers any persn wh arrives in a place and intends t stay there fr mre than 24 hurs but less than 3 mnths. Attendance utside the practice premises Practice area: there are tw definitins applying. Under the GMS Cntract/ Regs it is defined as the area in respect f which persns resident in it will, subject t any ther terms f the relevant cre cntract relating t patient registratin, be entitled t register with the cntractr, r seek acceptance by the cntractr as a temprary resident. Under the PMS Regs it is defined as the area specified in the PMS Agreement as the area in which essential services are t be prvided; Under the PMS Agreement it is defined as the gegraphical area frm time t time in respect f the ppulatin f which the cmmissiner is legally respnsible fr the prvisin f r payment fr healthcare services. Psitin under the PMS & GMS Cntract/ Regs Where, in the reasnable pinin f the cntractr, the medical cnditin f a patient is such that i) attendance n the patient is required, and ii) it wuld be inapprpriate fr the patient t attend the cntractr s premises then the cntractr must prvide services t the relevant patient at, what the cntractr believes, is the mst apprpriate f the fllwing:- the patient s last hme address; such place that the cntractrs has ntified the patient and cmmissiner as the place where they have agreed t visit and treat the patient; anther place in the cntractr s practice area. [GMS Regs Sch 2 Reg 5 replicated in clause f the GMS Cntract] [PMS Regs Sch 2 Reg 6 replicated in clause 7.10 f the PMS Agreement] Nne. Out f Hurs Services Meaning f definitins used in this sectin (which replicate thse cntained in bth the GMS and PMS Regulatins). Psitin under the GMS Cntract/ Regs Psitin under the PMS Agreement/ Regs The cre differences are:-

5 OOH Services: being thse essential services that a cntractr prvides its registered patients during cre hurs. OOH Perid: means: - 6pm t 8am Mnday t Thursday; and - 6pm n a Friday t 8 am the fllwing Mnday; and - Gd Friday, Christmas Day and bank hlidays Any GMS cntract must prvide fr the prvisin f OOH services during the OOH Perid. A cntractr is nly required t prvide these services if, in their reasnable pinin having regard t the patient s medical cnditin, it wuld nt be reasnable in all the circumstances fr the patient t wait t btain such services during cre hurs. Opt ut f OOH Services under the GMS Cntract/ Regs The cntractr can pt ut f prviding OOH Services. T d s the cntractr must serve written ntice specifying the date (which must be either three r six mnths after the ntice is given) upn which the prvisin f OOH Services are t cease. The cmmissiner must apprve the ntice as sn as is reasnably practicable and in any event within 28 days f receiving ntice frm the cntractr. NOTE there is an issue with the way in which the Regs are drafted in the sense that there is a clear cnflict as t whether NHSE has discretin in accepting a cntractr s pt ut ntice. The Regs are prly drafted. Part 6 Reg 38 (3) states that the Bard must Any agreement under which essential services are t be prvided must prvide fr the prvisin f ut f hurs services thrughut the ut f hurs perid unless Prir t signing the agreement the cmmissiner has accepted in writing a written request frm the cntractr that the agreement shuld nt require the cntractr t make such prvisin; The cntractr has pted ut (in accrdance with Pt 6) The agreement has been varied t exclude a requirement t make such a prvisin. [Reg 22 (1))] Except where the agreement prvides therwise, even where a cntractr is required t prvide OOH he is nly required t d s if, in their reasnable pinin having regard t the patient s medical cnditin, it wuld nt be reasnable in all the circumstances fr the patient t wait t btain such services. Opt ut f OOH Services under the PMS Agreement/ Regs As is the case under the GMS Regs the cntractr can pt ut f prviding OOH Services and the prcess f ntificatin is the same. As such any cntractr wanting t pt ut f A GMS cntract autmatically includes the need t prvide OOH services whereas a PMS Agreement can, where agreed prir t it being signed, exclude the prvisin f OOH services. A PMS Agreement can, with the agreement f the cmmissiner, be varied t exclude the requirement t prvide the OOH services.

6 apprve the ut f hurs ntice. This suggest there is n discretin in reaching their decisin. This cnflicts with Reg 38 (4) which states that the Bard will give its decisin as sn as pssible. prviding OOH Services must serve written ntice specifying the date (which must be either three r six mnths after the ntice is given) upn which the prvisin f OOH Services are t cease. The cmmissiner must apprve the ntice as sn as is reasnably practicable and in any event within 28 days f receiving ntice frm the cntractr. NOTE as is the case with the GMS Regs there is an issue with the way in which the PMS Regs are drafted in the sense that there is a clear cnflict as t whether NHSE has discretin in accepting a cntractrs pt ut ntice. The Regs are prly drafted. Part 6 Reg 30 (3) states that the Bard must apprve the ut f hurs ntice. This suggest there is n discretin in reaching their decisin. This cnflicts with Reg 30 (4) which states that the Bard will give its decisin as sn as pssible. Additinal services Additinal services: this is defined as ne r mre f the fllwing: (i) (ii) (iii) (iv) (v) (vi) (vii) cervical screening services; cntraceptive services; childhd vaccines and immunisatins; vaccines and immunisatins; child health surveillance services; maternity medical services; and minr surgery; Psitin under the GMS Regs A cntract may prvide fr the prvisin by the cntractr f additinal services. Where the cntractr is under cntract t prvide additinal services: Psitin under the PMS Regs Additinal services are nt cvered under the PMS Regs. Psitin under the PMS Agreement The PMS Agreement prvides fr the pssibility f additinal services being supplied by the GP practice. In ding s it mirrrs the requirements that are In relatin t the verarching bligatin sin respect f the prvisin f additinal service, nne.

7 the cntractr must make such facilities and equipment as are necessary available t enable them t be prperly perfrmed. Psitin under the GMS Cntract The GMS Cntract extends these bligatins by stipulating that the additinal services must be supplied t their registered patients and persns accepted as temprary residents where they are funded by the glbal sum, must: Prvide the additinal services at such times within cre hurs as are apprpriate t meet the reasnable needs f its patients; Have in place arrangements fr its patients t access such services thrughut the cre hurs in the case f emergency. placed n their GMS clleagues in the sense that:- the cntractr must make such facilities and equipment as are necessary available t enable the additinal services t be prperly perfrmed. they must be supplied t their registered patients and persns accepted as temprary residents where they are funded by the glbal sum, they must be prvided at such times within cre hurs as is apprpriate t meet the reasnable needs f the cntractrs patients. the cntractr must have in place arrangements fr its patients t access such services thrughut the cre hurs in the case f emergency. Sub cntracting f wrk Psitin under the GMS Cntract/ Regs Sub cntracting services ther than OOH Services Psitin under the PMS Agreement/ Regs Sub cntracting the prvisin f services is permitted where the Whereas a PMS practice has the ability t sub cntract withut the apprval f the cmmissiner where it is

8 The sub cntracting f services is permitted where: The cntractr has taken reasnable steps t satisfy itself that The sub cntracting is reasnable in the circumstances; The persn t whm the services are sub cntracted is/ are qualified and cmpetent t prvide the services Except i) in the case f OOH Services (discussed belw) r ii) where the sub cntract is with a health care prfessinal, the cntractr has served ntice f the prpsed sub cntract and the sub cntractr n the cmmissiner. [Upn receipt f such ntice the cmmissiner has 28 days t raise an bjectin t the prpsal.] The sub cntract des nt relate t the prvisin f essential services t a cmpany r firm that is whlly r partly wned by the cntractr has taken reasnable steps t satisfy itself that The sub cntracting is reasnable in the circumstances; The persn t whm the services are sub cntracted is/ are qualified and cmpetent t prvide the services The persn t whm the services are sub cntracted hlds adequate insurance Aside frm this, the cntractr must als:- - Ensure that it ntifies the cmmissiner as sn as reasnably practicable f the sub-cntract; - Ensure that the subcntractr has n ability t further sub cntract the relevant services; - Ensure that the sub cntractr is nt a cmpany r firm that is whlly r partly wned by the cntractr, r by any frmer r current emplyee f, r partner r sharehlder in, the cntractr; frmed by r n behalf f the cmfrtable with the persn wh is r will be prviding the services, the psitin with a GMS cntractr is slightly mre cmplex. A GMS cntractr must have the prir apprval f the cmmissiner unless the sub cntract is with i) a healthcare prfessinal r ii) (in the case f OOH Services) is with ne f fur specified peple (including anther GMS cntractr wh is cntracted t prvide OHH Services themselves). (See Paragraph f the GMS Cntract )

9 cntractr, r by any frmer r current emplyee f, r partner r sharehlder in, the cntractr; frmed by r n behalf f the cntractr, r frm which the cntractr derives a pecuniary benefit r frmed by r n behalf f any frmer r current emplyee f, r partner r sharehlder in, the cntractr, r frm which such persn derives a pecuniary benefit and which is r was frmed whlly r partly fr the purpse f aviding restrictins f the sale f gdwill. cntractr, r frm which the cntractr derives a pecuniary benefit r frmed by r n behalf f any frmer r current emplyee f, r partner r sharehlder in, the cntractr, r frm which such persn derives a pecuniary benefit and which is r was frmed whlly r partly fr the purpse f aviding restrictins f the sale f gdwill. NOTE the PMS Agreement des have square bracketed prvisins which extend beynd the Regs. These prhibit sub cntracting unless therwise agreed in writing by the cmmissiner. Sub cntracting OOH Services The sub cntracting f OOH Services is permitted:- i) with the prir written apprval f the cmmissiner; r ii) where the sub cntract is t prvide OOH

10 iii) Services n a shrt term r ccasinal basis; r where the prpsed sub cntractr is a persn hlding a GMS cntract which includes OOH Services, a PMS Agreement which includes a requirement t prvide essential services during all r part f the OOH Perid, healthcare prfessinals wh prvide OOH Services persnally under a cntract fr service r a grup f medical practitiners wh prvide OOH Services fr each ther under infrmal rta agreements. Duratin f the Agreement Grunds fr terminatin Psitin under the GMS Cntract/ Regs Unless a temprary cntract f nt mre than 12 mnths, the cntract runs unless and until terminated in accrdance with its terms. Psitin under the GMS Cntract/ Regs Terminatin can ccur: Where bth parties agree. Psitin under the PMS Agreement/ Regs Similarly the cntract runs unless and until terminated in accrdance with its terms. Psitin under the PMS Agreement/ Regs Terminatin can ccur: Where bth parties agree. Nne but it is wrth highlighting the difference in the circumstances upn which the cmmissiner can terminate the agreement under the GMS and PMS Regs. See belw. The mst fundamental difference is that, unlike the PMS Regs/ cntract, the GMS Regs/ cntract d nt allw the cmmissiner t vluntarily serve ntice

11 Where the cntractr serves nt less than 6 mnths written ntice t terminate. Where, in the case f a cntract with an individual medical practitiner, that practitiner dies. Where a medical practitiner dies and the cnditins cncerning wh can hld a GMS cntract pursuant t Reg 5 are n lnger satisfied. By the cmmissiner:- Where infrmatin given t them befre the cntract was entered int was fund t be inaccurate r untrue in a material respect. Where there has been unlawful sub cntracting f the cntractrs wrk. Where the cntractr has breached the cntract and patient safety is at serius risk Where the cmmissiner cnsiders that the cntractr s financial status is such that the cmmissiner Where either party serves nt less than 6 mnths written ntice t terminate. Where, in the case f a cntract with an individual medical practitiner, that practitiner dies. By the cmmissiner:- Where infrmatin given t them befre the cntract was entered int was fund t be inaccurate r untrue in a material respect. Where there has been unlawful sub cntracting f the cntractrs wrk. Where the cntractr has breached the cntract and patient safety is at serius risk Where the cmmissiner cnsiders that the cntractr s financial status is such that the cmmissiner wuld be at risk f material financial lss. Where ne f the varius fault f fitness grunds t end their cre cntract. This right is bestwed slely n the cntractr.

12 wuld be at risk f material financial lss. Where ne f the varius fault f fitness grunds cntained in Schedule 2 Part 8 Reg 58 (4) apply t the cntractr (including natinal disqualificatin). cntained in Schedule 2 Part 8 Reg 58 (4) apply t the cntractr (including natinal disqualificatin). Prvisin f infrmatin Psitin under bth the GMS & PMS Agreement/ Regs N later than 28 days after the same has been requested by the cmmissiner, the cntractr must prvide the cmmissiner (r such persn authrised in writing by the cmmissiner) r allw them access i) Any infrmatin which is reasnably required by the cmmissiner fr the purpse f r in cnnectin with the OMS cntract; and ii) Any ther infrmatin which is reasnably required in cnnectin with their functins. The cntractrs is required t either prvide the cmmissiner (r smene authrised in writing by the cmmissiner) Reg 74 f the GMS Regs/ Clause 16.8 f the GMS cntract Reg 67 f the PMS Regs/ Clause 38 f the PMS Agreement Nne. The prvisins replicate ne anther. Persnal Data Under the GMS Regs the cntractr must nminate a persn with the respnsibility fr practices and prcedures relating t the cnfidentiality f persnal data they hld. Under the PMS Regs the cntractr must nminate a persn with the respnsibility fr practices and prcedures relating t the cnfidentiality f persnal data they hld. The PMS Agreement intrduces far brader bligatins and requirements than are cntained in the GMS Regs and/r GMS Cntract. Many are,

13 The GMS cntract prvides n additinal express requirements beynd this. Other than this the PMS Agreement intrduces additinal cntractual requirements, namely:- i) The requirement that they cmply fully and in all respects with the prvisins f the Data Prtectin Act 1998; ii) The requirement t have regard t the prvisins f the Cnfidentiality and Disclsure f Infrmatin: General Medical Services, Persnal Medical Services and Alternative Prvider Medical Services Cde f Practice (as amended frm time t time); iii) Cmply with the Cnfidentiality Cde f Practice fr NHS Staff; iv) Cmply with Prtecting and Using Patient Infrmatin (a manual fr Caldictt Guardians); v) Appint a senir clinician t perfrm the rle f Caldictt Guardian and make available n request the name and cntact details f the Caldictt Guardian t the Bard; vi) Cmply with the NHS infrmatin Gvernance Tlkit (t the extent hwever, a mt pint. Fr instance a requirement t cmply with the Data Prtectin Act 1998, as prvided fr in the PMS Agreement, is a requirement that wuld apply t all cntractrs irrespective f whether they are under a requirement under their cre cntract r NHS Regulatins t cmply with it.

14 vii) that it applies t the cntractr); Cmply with the security management standard BS Representatives Psitin under bth the GMS Cntract/ Regs There are n prvisins relating t the appintment f a representative t act as fcal pint frm whm and t whm cmmunicatins are t be made. Psitin under bth the PMS Agreement/ Regs Althugh the PMS Regs d nt cntain any prvisins relating t representatives the mdel PMS Agreement des. In ding s it identifies:- Oher than the need t prvide a representative which is a requirement under the mdel PMS Agreement, nne. That the cntractr will appint a representative (and ntify the cmmissiner prmptly f any change) wh shall be the key pint f cntact that the cmmissiner may refer all queries and day t day cmmunicatins regarding the peratin f the PMS Agreement that is in place; That the cmmissiner will appint a representative (and ntify the cntractr prmptly f any change) wh shall be the key pint f cntact that the cntractr may refer all queries and day t day cmmunicatins regarding the peratin f the PMS Agreement that is in place.

15 Cmpliance with quality standards Gd Practice: defined within the PMS Agreement as using standards, practices, methds and prcedures cnfrming t the law and exercising that degree f skill, care, diligence, prudence and fresight which wuld reasnably and rdinarily be expected frm a skilled, efficient and experienced clinical services cntractr prviding clinical services and/r engaged in peratins similar t the services [being prvided under the cre cntract] under the same r similar t the bligatins f the relevant party under this agreement whilst at the same time cmplying with any specific standards set ut in this agreement r ntified t the cntractr by the [cmmissiner] frm time t time; Serius Incident Reprting: defined in the PMS Agreement as the reprting prcess as set ut in the Bard s incident reprting plicy. Psitin under bth the GMS & PMS Agreement/ Regs Bth the GMS and PMS Regs prvide limited prvisins specifically relating cmpliance with quality standards. These prvisins relate t OOH Services and state:- Where the cntractr des nt prvide OOH services, they must mnitr the quality f the OOH Services which are ffered r prvided t its registered patients having regard t the Natinal Quality Requirements in the Delivery f Out f Hurs Services and recrd, and act apprpriately in relatin t, any cncerns arising. They must frward n any cncerns ver the quality f the OOH services being prvided t the cmmissiner Where the cntractr des prvide OOH services they must meet the quality requirements in the Natinal Quality Requirements in the Delivery f Out f Hurs Services Further prvisins unique t the GMS Regs/ Cntract Further prvisins unique t the PMS Regs/ Cntract As is clear frm the further prvisins prvided under the PMS Regs/ Cntract, the PMS Agreement intrduces far brader bligatins and requirements than are cntained in the GMS Regs and/r GMS Cntract. It is wrth pinting ut that irrespective f the differences, bth GMS and PMS practices will be equally subject t the requirements f CQC. Aside frm the abve there are n further specific prvisins cntained in the GMS Regs r GMS Cntract which specifically deal with cmpliance with quality standards The PMS Agreement places practices under significantly mre express requirements in cnnectin with quality standards. These are cntained in clause 9 f the mdel PMS Agreement and require the cntractr t:- Cperate with patient satisfactin surveys that may be carried ut by the Department f Health, the cmmissiner r any ther apprpriate NHS bdy;

16 meet all perfrmance requirements under the PMS Agreement; cmply with all NHS requirements ntified t them by the cmmissiner including the cre quality standards cntained within Standards fr Better Health; carry ut the services in accrdance with Gd Practice; cmply with the standards and recmmendatins in the Fundamental Standards, thse issued by the Natinal Institute fr Health an Care Excellence, issued by any relevant prfessinal bdy and agreed between the parties, and frm any audit and serius untward incident and Serius Incident Reprting. In additin t the abve, the PMS Agreement places cntractrs under an express bligatin t:- ensure all staff are infrmed and are aware f the standard f perfrmance they are required t prvide; mnitr the cmpliance with such standards and taken actin t remedy any faults; prvide evidence t the cmmissiner, n request,

17 that they have cmplied with the abve prvisins. Clinical gvernance Cntrlled drugs: means any drug listed in Part I, II r II f Schedule 2 f the Misuse f Drugs Act 1971 (as amended) : System f clinical gvernance: defined as being a framewrk thrugh which the cntractr endeavurs cntinuusly t imprve the quality f its services and t safeguard high standards f care by creating an envirnment in which clinical excellence can flurish. Under bth the GMS and PMS Regs the cntractr must:- 1. Have in place an effective system f clinical gvernance which includes apprpriate standard perating prcedures in relatin t the management and use f cntrlled drugs. [GMS Regs - Part 14 Reg 87 / PMS Regs Part 14 Reg 79] 2. Nminate a persn (wh must be a persn wh perfrms r manages the perfrmance f services under relevant cre cntract) wh is respnsible fr ensuring the peratin f the system f clinical gvernance. [GMS Regs - Part 14 Reg 87 / PMS Regs Part 14 Reg 79] 3. Cperate with the cmmissiner in the discharge f any bligatins f the cmmissiner r its accuntable fficers under s17 (accuntable fficers and their respnsibilities as t cntrlled drugs) and 18 (cperatin between health bdies and ther rganisatins) f the Health Act 2006 [GMS Cntract cl / PMS Agreement cl 11.3 ] Althugh there is significant crss ver between the GMS and PMS Regs the PMS Agreement intrduces a wide bligatin t cmply with additinal requirements cncerning clinical gvernance which the cmmissiner may (frm time t time) advise. Save fr the abve there are n further prvisins cncerning clinical gvernance in the GMS Regs r GMS Cntract. The PMS Agreement identifies that the need fr the cntractr t cmply with the abve bligatins is withut prejudice t their bligatins t meet all perfrmance requirements under the PMS Agreement including the bligatin t cmply with Standards fr Better Health; and cmply with the cmmissiner s reasnable instructins frm time t time (including cmpliance with their clinical gvernance

18 requirements as are ntified t the cntractr frm time t time). Staff & cnditins fr emplyment/ engagement Exempt medical practitiner Medical perfrmers list Medical register Under bth the GMS and PMS Regs there are varius requirements cncerning the staff used in prviding services under the relevant cntract. These cver:- 1. Qualificatins f medical practitiners: the general verarching psitin (albeit there are sme exclusins) is that any medical practitiner prviding services must:- a. Be included in the medical perfrmers list; b. Nt suspended frm the perfrmers list f frm the medical register; c. Nt subject t interim suspensin. d. Is a requirement that n health care prfessinal may perfrm services under the relevant cntract unless that persn has such clinical experience and training as is necessary t enable the persn t prperly perfrm the services. Althugh there is significant crss ver between the GMS and PMS Regs the PMS Agreement clearly intrduces a variety f express and quite prescriptive additinal requirements n cntractrs when it cmes t the handling f their staff. 2. Qualificatins f health care prfessinals: the general verarching psitin (albeit there are again sme exclusins) is that any health care prfessinal prviding services must:- a. Be registered with the prfessinal bdy relevant t that health care prfessinal s prfessin; and b. That registratin must nt be subject t a suspensin. 3. Experience f health care prfessinals: they must have such clinical experience as is necessary t enable the persn t prperly perfrm such services. 4. Pre emplyment checks: these are brken dwn int three, namely:

19 Cnditins fr emplyment r engagement. ther than an exempt medical practitiner, the cntractr must, befre emplying r engaging either a medical practitiner r health care prfessinal:- a. Obtain dcumentary evidence that i) in the case f a practitiner, they are entered in the medical perfrmers list and ii) in the case f a health care prfessinal, they are registered with their relevant prfessinal bdy and nt subject t any frm f suspensin; and b. Check that they have the clinical experience necessary t enable the persn t prperly perfrm services under the relevant cre cntract Where the emplyment r engagement f a medical practitiner and/r a health care prfessinal is urgently needed and it is nt pssible t check these matters then the relevant medical practitiner / healthcare prfessinal can be emplyed r engaged fr a perid nt exceeding seven days whilst the checks are carried ut. Clinical references. Other than a GP Registrar, the cntractr may nt emply r engage a healthcare prfessinal t perfrm service sunder their cntract unless: a. They have tw clinical references relating t tw recent psts which lasted mre than three mnths withut break r (where this is nt pssible) a full explanatin f why this is the case and details f alternative referees; and b. Have checked the references. Where the emplyment r engagement f a health care prfessinal is urgently needed and it is nt pssible t btain these references then the relevant health care prfessinal can be emplyed r engaged fr a perid nt exceeding furteen days (extended by anther seven if there is reasn t believe the referee is ill n hliday r temprarily unavailable fr sme ther reasn) whilst the checks are carried ut.

20 Where a cntractr emplys r engages the same persn n mre than ne ccasin within a three mnth perid they can rely n their frmer references prvided these references are nt mre than 12 mnths ld. Verificatins f qualificatins. In relatin t the emplyment r engagement f any persn t assist in the prvisin f services (s it wuld apply t all staff) then the cntractr must take reasnable steps t satisfy itself that the persn in questin is suitably qualified and cmpetent t discharge the duties fr which they are engaged. Particular regard t their academic and vcatinal qualificatins, educatin and training and previus emplyment r wrk experience shuld be taken. 5. Arrangements fr GP Registrars. When emplying Registrars the cntractrs must be aware that:- a. by reasn f having emplyed a Registrar the ttal number f hurs fr which ther medical practitiners perfrm primary medical services (r indeed fr which ther staff wh assist thse practitiners in the prvisin f these services) is nt reduced. b. the terms f emplyment they ffer (including rates f pay) must be thse apprved by the Secretary f State. c. take accunt f the guidance entitled A reference Guide fr Pstgraduate Speciality Training in the UK. Aside frm the abve prvisins (which similarly apply t GMS cntracts and PMS Agreements), GMS cntractrs are als subject t the fllwing additinal bligatins which are enshrined in the GMS Regs themselves:- As is widely knwn, the GMS Regs places the cntractr under an bligatin t Aside frm the abve prvisins (which similarly apply t GMS cntracts and PMS Agreements), PMS practices are als subject t the fllwing additinal express bligatins which althugh are nt cntained in the PMS Regs are cntained within the mdel PMS Agreement:-

21 ensure that any general medical practitiner is ffered terms n less favurable than thse agreed within the mdel cntract agreed between the BMA and the NHS. [Reg 49] Where either the registratin f a health care prfessinal r in the case f a medical practitiner, the inclusin f that practitiner's name in a primary care list is subject t cnditins, the cntractr must ensure cmpliance with thse cnditins in s far as they are relevant t the cntract. [Reg 42] The cntractr is under an bligatin t ensure that any general medical practitiner is ffered terms n less favurable than thse agreed within the mdel cntract agreed between the BMA and the NHS. [Cl 20.17] If either the registratin f a health care prfessinal r in the case f a medical practitiner, the inclusin f that practitiner's name in a primary care list is subject t cnditins, the cntractr must ensure cmpliance with thse cnditins in s far as they are relevant t the cntract. [Cl 20.4] The cntractr must emply r engage a sufficient number f clinical and nn clinical staff t realise their bligatins t prvide services under their PMS Agreement. [Cl 19.1] The cntractr must ensure that they have a sufficient reserve f trained and cmpetent staff t prvide

22 services during hlidays r absence and during actual r anticipated peaks in demand fr the service. [Cl 19.1] The cntractr must prvide a sufficient number f staff at a supervisry and management level (with sufficient skills and training) t ensure that all staff are adequately supervised and managed prperly. [Cl 19.2] The cntractr (at their sle cst) must ensure that all staff underg reasnable medical screening, examinatins r tests if requested by the cmmissiner. [Cl 19.3] The cntractr will maintain detailed recrds f their staff (including name and place f duty, starting and finishing times, disciplinary actin, infrmatin t cnfirm cmpliance with the pre emplyment checks and verificatins required etc.). These recrds are t be made available t the cmmissiner n reasnable request. [Cl 19.4] The cntractr shall cmply with the NHS Emplyment Check Standards and such

23 ther checks as required by the Disclsure Barring Service r such ther checks required by natinal guidelines and plicies. [Cl 19.5] The cntractr shall emply r engage such persns in prviding services under their PMS Agreement wh: Are registered with the apprpriate prfessinal bdy (if relevant) Pssess the apprpriate qualificatins, experience and skill t perfrm the duties required f them (where this is nt the case they must be supervised) Are careful, skilled and cmpetent in practicing their duties. [Cl 19.6] The cntractr shall ensure that every member f staff:- Receives prper and sufficient training and instructin in accrdance with Gd Practice and in accrdance with the standards required

24 by their relevant prfessinal bdy; Has reasnable pprtunity t undertake the apprpriate training; Are prvided with all necessary and apprpriate supprt t facilitate them in develping career prgressin pathways. [Cl 19.7] NHS Branding There are n specific prvisins n NHS Branding in the GMS Regs and/r GMS Cntract Albeit nt a requirement identified in the PMS Regs, the PMS Agreement (at clause 88.1) prvides that a PMS practice:- Must designate and brand their premises as facilities frm which NHS services are t be prvided; May use their wn branding n their premises and in cmmunicatin where such branding is apprved by the Department f Health. That the PMS Agreement intrduces a requirement t identify that their premises are facilities frm which NHS services are prvided. Any ther branding used n premises needs the prir apprval f the Department f Health.