The National Health Service (Performers Lists) Directions 2010 (the "Directions") issued by the Secretary of State for Health come into force on 1 April 2010.

The Directions are part of an ongoing review of the performers list system (the "System") triggered by the 2007 White Paper entitled Trust, Assurance and Safety – the Regulation of Health Professionals in the 21st Century.  The White Paper aspired to a System that 'maintains the justified confidence of patients in those who care for them as the bedrock of safe and effective clinical practice and the foundation for effective relationships between patients and health professionals.'

The review so far

The review of the System has consisted of an informal consultation by the Department of Health with individuals who indicated an interest in the review and Strategic Health Authorities on a range of questions on the operation of the System and improvements and alternatives to it.

The Regulations

The Directions should be read in conjunction with the National Health Service (Performers Lists) Regulations 2004 (as amended) (the "Regulations").

The review obligations on PCTs

The Directions require PCTs to undertake three specific reviews (the "Reviews") of their procedures in relation to the management of their medical, dental and ophthalmic lists (the "List"):

1. Applications for inclusion on a List

PCTs must review their procedures for:

1.1 Verifying the identity of applicants;

1.2 Checking that the information provided by or in relation to an applicant is complete, accurate and authentic;

1.3 Satisfying itself that the applicant intends to perform services which those included on the relevant List perform;

1.4 Satisfying itself that the applicant has the knowledge of English necessary to perform the relevant services. PCTs should have regard to the interim guidance recently published by the Department of Health on language testing of overseas doctors applying for inclusion on the List. Please see Bevan Brittan's health alert for further information on this.

2. Notifications and disclosures of information

PCTs must also review their procedures for:

2.1 notifying specified bodies and persons about an applicant to or a performer on its List when:

2.1.1refusing to admit an applicant to the List on mandatory grounds, or when imposing conditions on the applicant (conditional inclusion); and

2.1.2 when suspending, removing, or contingently removing a performer from the List; and

2.2 disclosing information about applicants and performers to specified bodies and persons

In addition, PCTs must review their procedures relating to the disclosure of information about applicants and performers in the following circumstances:

2.3 Upon receipt of a request for information from another PCT or "UK health services body"; and

2.4 Upon receipt of information that an applicant or performer is included on the List of another PCT or any equivalent list published and maintained by a UK health services body.

A UK health services body means a Local Health Board in Wales, a Health Board in Scotland and a Health and Social Services Board in Northern Ireland.

3. Keeping Lists up to date

This review must also cover the PCT's procedures relating to the removal from a List of a performer who cannot demonstrate that they have performed the relevant services during the preceding 12 months.

When undertaking the Reviews, PCTs should have regard to the Department of Health guidance on managing Lists published in 2004: Primary Medical Performers Lists, Delivering Quality in Primary Care – Advice for Primary Care Trusts on List Management.

Requirement to draw up procedures

If PCTs do not already have the procedures set out in the Reviews in place, they are obliged to draw up such procedures and implement these at the earliest opportunity, and in any event by 31 March 2011.

Action following the reviews

Following completion of the Reviews, the PCT must consider whether any of their procedures require amendment to minimise the risk to the public from performers. This will involve the PCT analysing the outcomes of the Reviews and determining whether their procedures could be improved. Then, the PCT is required to actually amend the procedures and implement those amendments at the earliest opportunity.

The timescale

PCTs must undertake and complete the Reviews by 1 July 2010.

Any amendments to the procedures in light of the Reviews must be implemented by 31 March 2011.

Ongoing review obligations

PCTs are required to continue to undertake the Reviews at regular intervals going forwards and in particular when the Regulations are amended, or the Secretary of State issues further directions concerning the Regulations.

What does it mean for PCTs?

PCTs must:

  1. Undertake wholesale Reviews of their System; and
  2. Analyse the outcomes of their Reviews; and
  3. Devise and implement amendments to its procedures under their System; and
  4. Put in place systems for ongoing Reviews

…and they must do all this in a very demanding timescale.

What if your PCT commissions the procedures outlined in the Reviews to an external provider?

Many PCTs commission external providers (e.g. shared service agencies) to manage the administrative arrangements relating to their Lists. However, the PCT retains legal responsibility for ensuring that these Reviews are carried out and that the follow up actions are undertaken in relation to their System.

It is therefore important that PCTs who outsource their List management functions to third parties engage with their providers immediately to ensure that the Reviews are undertaken and that any consequent amendments to procedures are implemented within the prescribed timescales.

How can we help?

The Commercial Healthcare team at Bevan Brittan have worked with many PCTs in relation to List management matters, including the drafting and reviewing of List management policies and procedures (including procedures for handling oral hearings, reviews and appeals).

Our experience and expertise in these areas can be applied to assist you with organising and undertaking the mandatory Reviews, devising and implementing any necessary amendments to your procedures and System (or to design bespoke procedures and/or policies where none are in place currently) and assist in ensuring your ongoing List management arrangements comply with all relevant regulations, directions and guidance.

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