S.I. No. 44/1956:

MATERNITY AND CHILD HEALTH SERVICES (AMENDMENT) REGULATIONS, 1956.

MATERNITY AND CHILD HEALTH SERVICES (AMENDMENT) REGULATIONS, 1956.

The Minister for Health, in exercise of the powers conferred on him by section 5 of the Health Act, 1947 (No. 28 of 1947), and section 22 of the Health Act, 1953 (No. 26 of 1953) as amended by section 2 of the Health Act, 1954 (No. 23 of 1954), hereby makes the following Regulations :--

1. These Regulations may be cited as the Maternity and Child Health Services (Amendment) Regulations, 1956.

2. These Regulations shall come into operation on the 31st day of March, 1956.

3. Article 3 of the Maternity and Child Health Services (Amendment) Regulations, 1954 ( S.I. No. 158 of 1954 ) shall be revoked as from the commencement of these Regulations.

4. The women for whom services under section 16 of the Health Act, 1953 , shall be made available shall be women who are entitled to avail themselves of the institutional and specialist services made available under subsection (1) of section 15 of that Act.

5. The Maternity and Child Health Services Regulations, 1954 ( S.I. No. 98 of 1954 ) shall be amended as follows :--

(a) by re-inserting the following as sub-article (5) of Article 10, in lieu of the provision substituted for that sub-article by Article 8 of the Maternity and Child Health Services (Amendment) Regulations, 1954 :

" (5) The health authority shall, as soon as may be, notify the applicant and the medical practitioner or hospital authority of their decision on an application under this article."

(b) by inserting " domiciliary " before " attendance " in sub-article (1) of Article 11 ;

(c) by inserting " who gives to the appropriate medical practitioner or practitioners in the hospital concerned all appropriate information in his possession on the medical history and condition of the person requiring the services " at the end of sub-article (2) of Article 16 ;

(d) by deleting the word " and " in paragraph (b) of sub-article (1) of Article 20 and by adding at the end of that paragraph " if such an application has not already been sent to that authority by or on behalf of that person " ;

(e) by inserting " with the consent of the Minister " after " arrangements " in sub-article (1) of Article 21 ;

(f) by adding " who gives to the medical practitioner or practitioners providing the specialist services all appropriate information in his possession on the medical history and condition of the person requiring the services " at the end of sub-article (2) of Article 21.

6. Article 16 of the General Medical Services Regulations, 1954 ( S.I. No. 102 of 1954 ) shall apply in relation to the giving by district medical officers and midwives who are officers of health authorities of services under section 16 of the Health Act, 1953 , to women entitled to services under section 14 of that Act in the same way as that article applies in relation to the giving of services by district medical officers under the said Section 14.

7. The Forms MCA and MCD in the Schedule to these regulations shall be substituted for the Forms MCA and MCD in the Schedule to the Maternity and Child Health Services (Amendment) Regulations, 1954.

8. The Form MCB in the Schedule to these regulations shall be substituted for the Form MCB in the Schedule to the Maternity and Child Health Services Regulations, 1954.

SCHEDULE.

MEDICAL AND SURGICAL SERVICES FOR MOTHERS AND INFANTS.

APPLICATION FOR MEDICAL SERVICES.

TO BE COMPLETED BY THE APPLICANT.

I*...................................................of*........................in the County/ County Borough of....................................................... hereby apply to you to

(a)† accept me for medical and surgical services in respect of motherhood

(b)† provide medical and surgical services for my infant

under and in accordance with the provisions of the Health Act, 1953 , and the Regulations made under that Act.

Particulars in relation to my entitlement are overleaf.

I certify that these particulars are, to the best of my knowledge, accurate and complete and that I have not made arrangements for these services with another medical practitioner.

*Name and address in block letters

†Delete if not applicable.

Signature of applicant....................................

Date..........................................

To Dr...........................................................

N.B.--Knowingly to make any false statement or conceal any material fact in making this application is an offence punishable by a fine of £50 or by three months imprisonment, or both.

TO BE COMPLETED BY THE DOCTOR.

I undertake to provide medical and surgical services

(a)‡ for the person named above

(b)‡ for the infant

in accordance with the conditions laid down in the agreement made between me and the health authority for the provision of such services.

To the Secretary................................................County Council

" " City Manager and Town Clerk................................................

Signed ...................................................

Address .................................................

Date ..............................................

‡Delete if not applicable.

For Use in the Health Authority's Office.

PARTICULARS AS TO ENTITLEMENT.

PART I.--TO BE COMPLETED WHERE THE APPLICANT (OR HER HUSBAND) IS THE HOLDER OF A MEDICAL CARD ENTITLING HER TO THE DISPENSARY MEDICAL SERVICE UNDER section 14 of the act OR OF A LETTER NOTIFYING HER (OR HIM) THAT SHE IS ENTITLED TO OTHER SERVICES UNDER SECTION 14.

If you have completed Part I, the remaining Parts may be ignored.

PART II.--TO BE COMPLETED WHERE THE APPLICANT OR HER HUSBAND IS INSURED UNDER THE SOCIAL WELFARE ACT, 1952 .

If you have completed Part II, the remaining Parts may be ignored.

PART III.--TO BE COMPLETED WHERE THE APPLICANT'S (OR HER HUSBAND'S) MEANS ARE DERIVED WHOLLY OR MAINLY FROM FARMING.

If you have completed Part III, the remaining Part may be ignored.

PART IV.--TO BE COMPLETED ONLY WHERE THE APPLICANT IS NOT A PERSON COVERED BY PART I, II OR III ABOVE.

Note.--Further particulars as to the means of an applicant completing this Part of the Form may be required later.

Form MCB.                    Confidential

HEALTH ACT, 1953 .

MEDICAL CARE FOR MOTHERS AND INFANTS.

APPLICATION FOR INSTITUTIONAL OR SPECIALIST SERVICES.

I*.............................................of*..............................in the County/County Borough of..........................................hereby apply for institutional and specialist services--

(a)† for myself in respect of motherhood, or

(b)† for my child who is under six weeks old.

Particulars in relation to my entitlement are overleaf.

I certify that these particulars are, to the best of my knowledge, accurate and complete.

*Name and address IN BLOCK LETTERS

†Delete if not applicable

Signature of applicant....................

Date......................

To the......................................................County Council.

Corporation.

N.B.--Knowingly to make any false statement or conceal any material fact in making this application is an offence punishable by a fine of £50 or by three months imprisonment, or both.

PARTICULARS AS TO ENTITLEMENT.

PART I.--TO BE COMPLETED WHERE THE APPLICANT (OR HER HUSBAND) IS THE HOLDER OF A MEDICAL CARD ENTITLING HER TO THE DISPENSARY MEDICAL SERVICE UNDER section 14 of the act OR OF A LETTER NOTIFYING HER (OR HIM) THAT SHE IS ENTITLED TO OTHER SERVICES UNDER SECTION 14.

If you have completed Part I, the remaining Parts may be ignored.

PART II.--TO BE COMPLETED WHERE THE APPLICANT OR HER HUSBAND IS INSURED UNDER THE SOCIAL WELFARE ACT, 1952 .

If you have completed Part II, the remaining Parts may be ignored.

PART III.--TO BE COMPLETED WHERE THE APPLICANT'S (OR HER HUSBAND'S) MEANS ARE DERIVED WHOLLY OR MAINLY FROM FARMING.

If you have completed Part III, the remaining Part may be ignored.

PART IV.--TO BE COMPLETED ONLY WHERE THE APPLICANT IS NOT A PERSON COVERED BY PART I, II OR III ABOVE.

Note.--Further particulars as to the means of an applicant completing this Part of the Form may be required later.

Form MCD

PART I.

FORM OF AGREEMENT WITH REGISTERED MEDICAL PRACTITIONER.

HEALTH ACT, 1953 .

Form of Agreement with General Medical Practitioner under Article 6, 7 or 8 of the Maternity and Child Health Services Regulations, 1954.

I*..........................of *............................. (hereinafter called the registered medical practitioner) propose to provide services in accordance with the terms and conditions in Part II of Form MCD in the Schedule to the Maternity and Child Health Services (Amendment) Regulations, 1956 for persons for whom the*........................................................... (hereinafter called the Authority) are obliged to make such services available.

*Name and full address IN BLOCK LETTERS

*Insert name of health authority.

Part II of Form MCD in the Schedule to the Maternity and Child Health Services (Amendment) Regulations, 1956, shall be taken and construed as part of this agreement and references in the said Part II to the agreement, the medical practitioner, the health authority and the Regulations shall be construed as referring respectively to this agreement. the registered medical practitioner, the Authority and the Maternity and Child Health Services Regulations, 1954 ( S.I. No. 98 of 1954 ), (as amended).

Signed this...................day of

....................19........., by

the registered medical practitioner :--............................................................ .................................... in the presence of :--............................................................ ............................................................ ...

The Authority hereby accepts the above proposal of the medical practitioner for the provision by him of services in accordance with the terms and conditions aforesaid.

Signed this......................day of............19.........

................................................

Manager.

PART II.

TERMS AND CONDITIONS OF AGREEMENT WITH REGISTERED MEDICAL PRACTITIONER.

1. The medical practitioner agrees to provide under the terms of the agreement services for any eligible woman or child by or on whose behalf an application is made to him and whom he is willing to accept as a patient. Subject to Paragraph 24, nothing in this Paragraph shall be construed as requiring a medical practitioner to provide services under the agreement for any woman or child whom he is unwilling to accept as a patient, but, within two weeks of receiving an application to accept a woman or child as a patient, he shall, if he is unwilling to accept that woman or child as a patient, notify the applicant and the health authority.

2. The medical practitioner shall comply with the provisions of Articles 10 and 12 of the Maternity and Child Health Services Regulations, 1954, in relation to the completion of forms of application and claim and their transmission, with the appropriate record cards, to the health authority or the chief medical officer of such authority, as may be appropriate.

3. The medical practitioner shall, in respect of each woman entitled to avail herself of the service under section 16 of the Health Act, 1953 , whom he has accepted as a patient under this agreement or who has been assigned to him under paragraph 23 of these terms and conditions, provide such services as can appropriately be given by him and as he considers desirable in respect of motherhood : in particular, he shall provide such of the following services as are appropriate in respect of each such woman :--

Initial examination (to be carried out, where possible, not later than the sixth month of pregnancy) ; an examination where possible in each of the last three months of pregnancy ; such other examinations and ante-natal care as the medical practitioner considers necessary ; attendance at the confinement (if the medical practitioner considers it necessary or if his services are called for by a midwife attending on the patient) ; attendance on at least one occasion in the week following the delivery ; an examination (including a pelvic examination if thought necessary) at or about the end of the sixth week after the delivery ; such other examinations and post-natal care within the period of six weeks after the delivery as the medical practitioner considers necessary ; the taking of any specimens required for investigation.

4. The medical practitioner shall, in respect of each child whom he has agreed to accept as a patient, provide up to the age of six weeks such medical and surgical services (including at least one examination of the child) as can appropriately be given by him.

5. The medical practitioner shall provide the services in person except where he is unable for a good reason to do so. In such a case he shall, with the agreement (except in case of urgency) of the woman or a parent of the child, as the case may be, arrange for another registered medical practitioner to attend to provide the services. The health authority will not be responsible for any payment to the latter practitioner.

6. The medical practitioner shall make services under the agreement available, as may be agreed with the woman or a parent of the child, as the case may be, either in the patient's place of residence, in the medical practitioner's surgery or in a maternity home or other institution to which he has access. Where the medical practitioner is a district medical officer he shall not withhold or refuse to provide services which he has undertaken to provide in accordance with this agreement by reason of the refusal of the patient to attend for such services at the dispensary. If the medical practitioner is a district medical officer, attendance at the dispensary may, if the woman or a parent of the child (as the case may be) agrees, be arranged, subject to the approval of the health authority at such time as may be convenient to the medical practitioner and the patient.

7. The medical practitioner shall keep a record in a form approved of or directed by the Minister in relation to his attendance on a woman under the agreement and shall make any such record available, where required, for inspection by a medical officer of the health authority or of the Minister authorised in that behalf.

8. Where a woman to whom a record card compiled under paragraph 7 of these terms and conditions relates attends or is admitted to a hospital for services in respect of her pregnancy, the medical practitioner shall make the record card available on loan, or a summary of the information thereon, to the medical staff of the hospital.

9. Where the medical practitioner is a district medical officer he shall make available from dispensary stocks to any woman or child being attended by him in accordance with the terms of the agreement by whom or on whose behalf there is produced to him--

(a) a card issued in accordance with Article 11 of the General Medical Services Regulations, 1954, and for the time being in force,

(b) a direction issued in accordance with Article 16 of the said Regulations, and for the time being in force, or

(c) a direction issued by the health authority,

such drugs, medicines and surgical dressings and such minor appliances for use by the patient in connection with the administration of the said drugs and medicines as he considers necessary. In the case of any other patient being attended by him in accordance with the terms of the agreement, he shall prescribe for the patient such drugs, medicines and surgical dressings and such minor appliances as he considers necessary for use by the patient in connection with the administration of the said drugs and medicines.

10. Where the medical practitioner is not a district medical officer he shall prescribe for any woman or child being attended by him under the agreement such drugs, medicines and surgical dressings and such minor appliances for use by the patient in connection with the administration of the said drugs and medicines as he considers necessary. The medical practitioner shall use for this purpose a form supplied by the health authority provided there is produced by or on behalf of the woman or child a Card issued in accordance with Article 11 of the General Medical Services Regulations, 1954, and for the time being in force, or a direction issued in accordance with Article 16 of the said Regulations and for the time being in force, or a direction issued by the health authority. The medical practitioner may also use the form supplied by the health authority to prescribe for his own use such of the following items as may be required by him in the course of his attendance at the domiciliary confinement of women to whom he is affording services in accordance with the provisions of the agreement :--

(i) Ergometrine or other ergot preparation ;

(ii) Lobeline ;

(iii) Nalorphine (N-allylnormorphine) ;

(iv) Vitamin K ;

(v) Carbachol ;

(vi) Pethidine ;

(vii) Morphine Sulphate ;

(viii) Trilene ;

(ix) Chloroform ;

(x) Antiseptic Cream ;

(xi) Sutures and ligatures ;

(xii) Transfusion fluids (saline, glucose and glucose and saline)

The forms issued by the health authority shall not be used by the medical practitioner for any person other than a woman or a child by whom or on whose behalf a Card or direction as aforesaid is produced or for ordering items for his own use, except such of the aforesaid items as are required by him in the course of his attendance at the domiciliary confinement of women to whom he is affording services in accordance with the provisions of the agreement or for ordering for his own use items other than those which he is hereby authorised to order or for prescribing for any woman or child being attended by him items other than drugs, medicines and surgical dressings and minor appliances for use by the patient in connection with the administration of the said drugs and medicines.

11. The medical practitioner shall, without charge, furnish to the woman any certificate in relation to the pregnancy or to the parent of the child in relation to the health of the child which she or he may require for the purpose of obtaining admission to an institution, applying for a maternity benefit under section 23 of the Health Act, 1953 , or under the Social Welfare Act, 1952 , or for milk under section 24 of the Health Act, 1953 , or for obtaining any other benefit under the Health Acts, 1947 to 1954.

12. If the medical practitioner considers that any woman or child being attended by him under the agreement needs hospital or specialist services or any other service which may be made available by the health authority and which cannot appropriately be given by him, he shall inform the woman or a parent of the child (as the case may be) of the availability of such service and shall, if it is desired by the woman or parent, take appropriate steps to enable the woman or child to avail herself or himself of such service.

13. The health authority, in consideration of services provided by a medical practitioner in accordance with these terms and conditions, shall make payments to him in accordance with such scale as may be approved of or directed by the Minister from time to time. The health authority may, if they so think fit, refuse to make a payment in respect of a service given more than twenty-eight days before the appropriate application on Form MCA has been received by them.

14. The medical practitioner shall not demand or accept any payment or consideration whatsoever other than the payment under paragraph 13 of these terms and conditions in reward for services provided by him under the agreement or of travelling or other expenses incurred by him or of the use of any promises, equipment or instruments in making the services available. Nothing in this paragraph, however, shall be construed as preventing the acceptance by a medical officer of--

(a) his salary as a medical officer of a local authority hospital ;

(b) a payment from any fund which may be established for the remuneration of specialist staff in voluntary or proprietary hospitals.

15. The agreement shall be terminated forthwith where the medical practitioner's name is erased from the register of medical practitioners under the Medical Practitioners Act, 1927 (No. 25 of 1927).

16. The agreement shall be terminated, on such notice not exceeding three months as may be agreed to by the health authority, upon the medical practitioner being offered employment in a wholetime capacity in the service of the State or of a local authority.

17. The agreement may be terminated at any time by the medical practitioner giving notice to the health authority. Notice under this clause shall be given three months (or such shorter period as may be agreed to by the health authority) before such termination.

18. Where a health authority has reason to believe that a medical practitioner has failed to comply with any of the terms of the agreement they shall notify the medical practitioner of the reasons for such belief by registered post and inform him that they will consider any representations in regard to the matter which may be received by them from him within fourteen days of the issue of the notification to him. The health authority, if they are satisfied, after consideration of any representations which the medical practitioner may make in regard to the matter, that the medical practitioner has not complied with the terms of the agreement may if they think fit--

(a) issue a warning to the medical practitioner ;

(b) require the medical practitioner to pay them a fine not exceeding ten pounds, or

(c) terminate the agreement on one month's notice or such longer notice as the health authority considers adequate.

19. If a medical practitioner is aggrieved by a decision of a health authority in regard to any of the matters dealt with in Paragraphs 16, 17 or 18, he may appeal to the Minister for Health within twenty-eight days of the date on which the decision of the health authority is conveyed to him and the Minister, after consideration of such appeal and of the representations (if any) of such health authority in relation thereto shall either (as he thinks proper) refuse such appeal or give to such health authority such direction as he considers appropriate to the case.

20. The medical practitioner agrees to pay to the health authority any fine required to be paid by him in accordance with paragraph 18 or 19 of these terms and conditions.

21. Where a fine due by a medical practitioner under paragraph 18 or 19 of these terms and conditions has not been paid, the amount thereof may be deducted by the health authority from moneys payable by that authority to the practitioner.

22. The medical practitioner agrees to make available to a medical officer of the health authority or of the Minister authorised in that behalf any relevant information requested by such officer for the purpose of the investigation of any matter arising under paragraph 18 of these terms and conditions.

23. Where the woman, or a parent of a child (as the case may be) having made reasonable efforts in that behalf, has failed to come to an arrangement for the provision of services under section 16 or Section 17 of the Health Act, 1953 , for herself or the child and notifies the chief medical officer of the health authority accordingly, he may assign such woman or child to such one of the registered medical practitioners, between whom and the health authority agreements under Article 8 of the Regulations are in operation, as can, in the opinion of the chief medical officer, most conveniently make the relevant services available.

24. The medical practitioner agrees to accept any patient assigned to him under paragraph 23 of these terms and conditions and to make services available for such patient as if she or he had been accepted by the medical practitioner under these terms and conditions.

GIVEN under the Official Seal of the Minister for Health this ninth day of March, One Thousand Nine Hundred and Fifty-six.

THOMAS F. O'HIGGINS,

Minister for Health.