extra-contractual

Training does not make cash as extra-contractual referrals do, but it is an investment in Britain's health.

Fourthly, extra-contractual referrals are clearly at the discretion of the health authority concerned, but surely clinical decision must be the main criterion.

Therefore, the general rules of extra-contractual responsibility established by article 1457 of the Civil Code of Quebec apply.

However, once the health authority has placed those contracts in those terms, we come to the questions which determine the decisions about the honouring of extra-contractual referrals.

DHAs should have a clinical panel whose advice can be sought on GPs' pattern of extra-contractual referrals.

I contacted the North Devon District Health Authority and asked for an extra-contractual referral to be made for this operation.

Finally, we want existing Community laws to take precedence over the new directive, in particular private international law for contractual and extra-contractual obligations and everything connected with workers rights.

Thus, it continues, 'a presumption of the right to make an extra-contractual referral cannot therefore be a guarantee that the DHA would in all cases agree to meet the cost'.

Quasi-delict is a French legal term used in some civil law jurisdictions, encompassing the common law concept of negligence as the breach of a non-wilful extra-contractual obligation to third parties.

A duty is also placed on the provider in that 'when a hospital receives an extra-contractual referral, it will need to discuss with the patient's DHA the financial arrangements and other terms.'

There are few proposals to control other elements of a Type II 'internal market', ie extra-contractual emergency referrals and the treatment of temporary residents, although in many cases the dividing line between emergency and non-emergency is very narrow.

Common contractual problems include farmer sales to a buyer other than the one to whom the farmer is contracted (side selling or extra-contractual marketing), a company's refusal to buy products at the agreed prices, or the downgrading of produce quality by the buyer.

Indeed, what is advocated is largely Type I. However, the existence of elements of a Type I1 model, ie for emergency admissions, extra-contractual referrals and temporary residents, gives incentives to providers which will be very similar to those under insurance-based systems.

The assurance is given that such extra-contractual referrals will go unchallenged by the DHA 'unless it can be shown that the proposed referral is wholly unjustified on clinical grounds, or where an alternative referral would be equally efficacious for the patient, taking into account the patient's wishes'.

However, it continues, GPs cannot interpret the provisions for extra-contractual referrals as a licence to disregard the contract arrangements since DHAs are accountable for expenditures and 'cannot therefore be put in the position of being a mere cypher and reflecting individual GPs' wishes regardless of their effect on other patient services'.