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Independents' Day

GP practices given green light to close lists unilaterally in 'urgent' circumstances

Exclusive GP practices can legitimately take steps to ‘temporarily halt’ taking on new patients on an informal basis, if they face short-term problems providing adequate cover, according to advice issued to LMCs.

The NHS England statement, disseminated to LMCs by the GPC, supports GPC guidance on how practices should deal with list closures and comes after one GP was threatened with a breach-of-contract notice after taking steps to close his practice’s list informally, in line with the GPC advice.

However, the new guidance said that practices may take the ‘urgent action’ to stop registering new patients temporarily if they feel they need to – provided they then ask for help from the area team to sort the problem out.

It follows correspondence between NHS England and the GPC after Dr Hadrian Moss, a GP in Kettering, Northamptonshire, was contacted by the Central Midlands local area team to say he was in breach of his contract.

This followed a blog he wrote for Pulse explaining how he had decided to follow GPC advice to close his practice list informally.

Dr Moss said he took the step because the practice was struggling to cope, with GPs having to put in regular 10-hour days to make up for the loss of a partner who retired early this year and has yet to be replaced.

The row led to a question in the House of Commons, with health minister Daniel Poulter promising to ‘look into the matter’.

The new advice, revealed by GPC, says that practices would only need to make a formal application to close their list if ‘progress was not being made’.

The NHS England statement reads: ‘Because of our need to ensure we engage with the local community regarding the services we commission, we do not accept that a practice can close its list without going through a formal process of engagement.

‘However, we do appreciate that there are times when urgent action needs to be taken. If there is a sudden impact on a practice’s ability to provide patient services, we accept that a temporary halt to new patient registration is appropriate, but this should be followed quickly by a discussion with the commissioner to identify an action plan to address the issues. Where it is evident that the issues can be resolved within a short time scale, then we would look to support a practice address these issues without requiring formal list closure.’

It adds: ‘If progress was not being made, we would advise that consideration be given formally to close the list. Where a practice is opting to restrict patient registration without discussing the implications and appropriate actions with NHS England, we would consider whether contractual action ought to be taken.’

Dr Richard Vautrey, deputy chair of the GPC, told Pulse the statement reaffirmed the GPC’s advice and that NHS England was now taking a more supportive position.

He said: ‘What they have said has underlined the position we took. These incidences are a cry for help as much as anything. A practice needs the support of the area team and it would appear it is now starting to get that, which is a good thing.’

Pulse understands talks between Dr Moss and NHS England Midlands and East (Central Midlands) area team are continuing.

A spokesperson for the area team said: ‘We can confirm that a meeting has taken place with the practice, discussions are ongoing and there are no further updates as yet.’

An NHS England spokesperson said: ‘NHS England’s position on this issue has not changed. We have a responsibility to ensure that services are available to patients. We continue to work with the GPC on this important issue.’  

Readers' comments (11)

  • When it all goes pear shaped and god forbid harm comes to a patient, the area team, GMC, NHSE RCGP will not be there to help you out. Just make sure you don't default on your MDO as they are the only ones who will be of any use. Good luck

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  • I agree. Trust no one, they all want you to make a mistake so they can take your contract to sell you off to companies in the mist.

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  • Vinci Ho

    Look forward to your next article on this platform
    100% behind what you have been doing , mate.

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  • Personally, can't do it. I have a clause on my rent uplift which suggests that if I apply to close a list this rent may be reduced. I've had to struggle for 4 years to get it and now should I trust this ruling.....I doubt it. One has to understand NHSE Area Teams work differently in different areas and do not have a uniform approach. So one needs to assess the other side before one takes decisions. A plus for the Midlands Area Team and hearty congratulations to Hadrian for not giving up to pressure.

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  • I cant understand why as professionals we are not more in control of our working lives. Independant contractors my foot. The contract is toxic for GPs and should be replaced simply with do this work get thay money then those who want to work 12 hour days will be rewarded and those that dont will earn less. All the patients will be seen without complaint as all work will be paid for so no more disgruntled GPs, provided the fees are apropriate. This bullying to work beyond ones capability must stop as its neither good for patients nor staff.

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  • We are not in control because if government agencies work like mafias then even the legal system goes against its own citizens.
    Expect a 'bilateral' contract for 2015/2016 to be given to you to sign on the 31st of March and to be returned within 72 hours as is the usual practice in GP land. No questions asked- it's always take it or leave it.

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  • Inaccurate headline. Missed out the word 'temporarily'.

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  • 10:12 does that mean you agree with the remainder of the headline?

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  • 11.01 - no issues with the rest of the headline or the article's content; just that those only reading the headline would be mislead as to the story itself.

    That is routinely an issue with Pulse's tabloid approach.

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  • Our federation expects 8-8 working - so can we close our list permanently?

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