Amendments Relating to the Provision of Integrated Care Regulations 2019

These Regulations amend secondary legislation relating to the National Health Service, and the regulation of the medical professions in consequence of the implementation of integrated care provider (“ICP”) contracts. ICP contracts will be a single contract, through which general practice, wider NHS and, in some cases, local authority services can be commissioned from a lead provider organisation, responsible for delivering integrated care.

Part 2 amends the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 (S.I. 2003/2382). The amendments maintain the position that the travel expenses and the remission of certain charges are not available in the context of primary medical services. But the amendments also ensure that the existing entitlements to travel expenses and remission of charges are available in relation to an ICP contracts. A clarificatory amendment is also made in relation to sub-contracting.

Part 3 amends the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (S.I. 2009/309). The amendments ensure that requirements relating to the handling of complaints about health service provision apply to a greater range of persons and bodies in order to reflect new models of health service provision under an ICP contract. The amendments also ensure that requirements relating to the handling of complaints by local authorities about health or social care provision apply in a broader range of circumstances.

Part 4 amends the Medical Profession (Responsible Officers) Regulations 2010 (S.I. 2010/2841). The amendments insert a new definition of “integrated care provider” which is consequential on the changes made to designated bodies in the Schedule to those Regulations. Further definitions are also added to reflect the introduction of ICP contracts. Part 4 also inserts a new provision that enables an ICP to be the designated body for medical practitioners who are employed by it or provide to it health services other than primary medical services, under or pursuant to an ICP contract.

Part 5 amends the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (S.I. 2012/2996) (“the Standing Rules”). The amendments insert a new definition of “integrated care provider contract”, amend the definition of “commissioning contract” so that it includes such a contract, and excludes such a contract from the definition of “primary care contract”. These amendments ensure that the Standing Rules allow for commissioning of ICP contracts.

Part 6 amends the National Health Service (Performers Lists) (England) Regulations (S.I. 2013/335). The amendments insert definitions of an “APMS contract”, “integrated care provider contract” and “primary medical services” into those Regulations to include the new contractual arrangements for the delivery of primary medical services under an ICP contract. This enables medical practitioners performing services under these contracts to be on the medical performers’ list.

Part 7 amends the National Health Service (Licence Exemptions, etc.) Regulations 2013 (S.I. 2013/2677). The amendments amend the applicable turnover exemption in those Regulations by prescribing a new prospective assessment of applicable turnover. Providers of NHS health care services must estimate their prospective applicable turnover on the date they started providing NHS services, and every month thereafter, for the purpose of determining whether their applicable turnover is reasonably expected to be less than the £10 million exemption threshold in those Regulations. The new test requires providers that estimate that their applicable turnover will be less than the £10 million threshold to consider if any contracts they still hold previously required them to be licensed.

Part 8 amends the National Health Service (Charges for Drugs and Appliances) Regulations 2015 (S.I. 2015/570). The amendments clarify that primary medical services provided under section 83(2) of the National Health Service Act 2006, which were formerly only provided under arrangements between Alternative Medical Services Providers and the National Health Service Commissioning Board, may now be commissioned under ICP contracts. However, the underlying position of the circumstances in which prescription charges are levied, or exemptions from charging may be obtained, is unaltered.

Parts 9 and 10 amend respectively the National Health Service (General Medical Services Contracts) Regulations 2015 (S.I. 2015/1862) and the National Health Service (Personal Medical Services Agreements) Regulations 2015 (S.I. 2015/1879). These two sets of Regulations make provision in respect of the services provided under a general medical services (“GMS”) contract and a personal medical services (“PMS”) agreement made pursuant to Part 4 of the National Health Service Act 2006. The amendments make provision for a GP practice which holds a GMS contract or a PMS agreement to suspend the obligation to provide primary medical services under that contract or agreement, so that such services may be provided by that GP practice under an ICP contract. Provision is also made for a suspended GMS contract or PMS agreement to be reactivated at specified intervals and where specified conditions are met.

Part 11 makes transitional provision to ensure that where a complaint under the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (S.I. 2009/309) has started before this instrument commences, the complaint will proceed under those regulations as if this instrument had not been made.