Article 36 Payments under default contracts

(1)

Subject to the following provisions of this Part, where a Primary Care Trust enters into a default contract, the only payments that are to be made by the Primary Care Trust to the contractor under that default contract are the payments mentioned in this article (although this is without prejudice to any powers that the Primary Care Trust has to make payments to the contractor under other arrangements).

(2)

In respect of each complete month for which a default contract has effect, the Primary Care Trust must pay to a contractor under its default contract a reasonable approximation of one twelfth of what would have been the contractor’s final global sum equivalent if—

(a)

it had entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004; and

(b)

a calculation had, as a consequence, been made of its final global sum equivalent by the Primary Care Trust in accordance with Part 1 of the Statement of Financial Entitlements (global sum and minimum practice income guarantee),

minus, if appropriate, a monthly deduction in respect of superannuation.

(3)

If, while it has a default contract—

(a)

a contractor engages a locum to cover for the absence of a GP performer; and

(b)

had the contractor entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004, the Primary Care Trust would have been required to pay for, or to contribute towards the cost of, that locum by virtue of Part 4 of the Statement of Financial Entitlements (payments for specific purposes),

the Primary Care Trust must pay to the contractor under its default contract a reasonable approximation of the amount that the Primary Care Trust would have been required to pay towards the cost of that locum by virtue of Part 4 of the Statement of Financial Entitlements.

(4)

In respect of each complete quarter of the financial year for which a default contract has effect, the Primary Care Trust must pay to a contractor under its default contract a reasonable approximation of any quarterly seniority payment that would have been payable, at the end of that quarter, in respect of any GP provider who is a partner in the contractor if—

(a)

the contractor had entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004; and

(b)

a calculation had, as a consequence, been made of a reasonable approximation of the quarterly seniority payment in accordance with Parts 4 and 6 of the Statement of Financial Entitlements (payments for specific purposes, and supplementary provisions).

(5)

If, in the period during which a default contract has effect, the contractor claims from a Primary Care Trust a payment in respect of—

(a)

a standard, additional or further payment under the golden hello scheme;

(b)

a returners' scheme doctor payment;

(c)

a flexible career scheme contractor payment, a flexible career scheme doctor payment or a payment in respect of educational sessions under the flexible career scheme;

(d)

sessions undertaken by a member of the doctors' retainer scheme;

(e)

an educational allowance payment; or

(f)

dispensing services,

to which the contractor would have been entitled under Part 4 of the Statement of Financial Entitlements (payments for specific purposes), had the contractor entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004, and which would, in those circumstances, have fallen due by virtue of that Part, the Primary Care Trust must pay to the contractor under the default contract the amount that the Primary Care Trust would have been required to pay to it by virtue of Part 4 of the Statement of Financial Entitlements, had the contractor entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004.

(6)

If, in the period during which a default contract has effect, the contractor claims from a Primary Care Trust a payment—

(a)

towards the cost of building new premises to be used for providing medical services;

(b)

towards the cost of purchasing premises to be used for providing medical services;

(c)

towards the cost of the development of premises which are used, or are to be used, for providing medical services;

(d)

in the form of, or in the form of part of, a premises improvement grant; or

(e)

representing the reasonable costs of information technology maintenance or minor upgrades,

to which the contractor would have been entitled under Part 5 of the Statement of Financial Entitlements (certain premises and I.T. costs), had the contractor entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004, and which would, in those circumstances, have fallen due by virtue of that Part, the Primary Care Trust must pay to the contractor under the default contract the amount that the Primary Care Trust would have been required to pay to it by virtue of Part 5 of the Statement of Financial Entitlements, had the contractor entered into a general medical services contract with the Primary Care Trust on or before 31st March 2004.

(7)

If, in the period during which a default contract has effect, the contractor claims from a Primary Care Trust, in respect of its recurring premises costs—

(a)

payments in respect of the current market rent or actual lease rent of practice premises;

(b)

payments in respect of the lease costs of equipment, furniture or furnishings;

(c)

payments in respect of borrowing costs relating to practice premises;

(d)

notional rent payments or notional rent supplements in respect of practice premises; or

(e)

payments in respect of business rates, water and sewage charges, charges in respect of the collection and disposal of clinical waste or utilities and services charges,

in circumstances where the Primary Care Trust must, by virtue of Part 6 of the Premises Costs Directions (supplementary provisions), continue to provide financial assistance to the contractor by way of meeting or contributing towards the recurring premises costs relating to which the claim for payment is made, the Primary Care Trust must pay to the contractor under its default contract any payment it is required to pay pursuant to the Premises Costs Directions, to meet or contribute towards those recurring premises costs.

(8)

If, in the period during which a default contract has effect, the contractor claims from a Primary Care Trust a payment in respect of patients who are not registered patients but in relation to whom the contractor—

(a)

was (or a partner in the contractor was), on 31st March 2004, providing the following services—

(i)

child health surveillance services,

(ii)

contraceptive services,

(iii)

maternity medical services, or

(iv)

out of hours services;

(b)

was, (or a partner in the contractor was), on 31st March 2004, entitled to receive payments for providing those services from the Primary Care Trust under the Statement of Fees and Allowances; and

(c)

is required, by virtue of this Order, to continue to provide those services under its default contract,

the Primary Care Trust must pay to the contractor under its default contract a reasonable amount in respect of those services.